Our Solutions
Claims Management
Smarter Processing. Lower Costs. Happier Members.
Medical schemes today face growing pressure to control costs while delivering faster, fairer service to members and providers. Unfortunately, many schemes are still held back by outdated claims systems that cause delays, errors, unnecessary admin, and rising costs.
The Hidden Cost of Legacy Systems
Too many schemes remain dependent on infrastructure that:
- Require manual data entry and repetitive paperwork
- Lacks automation for standard claims workflows.
- Struggle with modern coding standards like ICD-10
- Provide limited visibility for members and providers
- Inflates operational costs and frustrates stakeholders.
These inefficiencies are more than administrative – they directly impact your bottom line and member satisfaction.
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How Smartchoice + Invidasys Transform Claims Processing
In partnership with Invidasys, Smartchoice delivers a modern claims management solution built to streamline operations and enhance service delivery:
This isn’t just an upgrade. It’s a transformation in how you deliver member value.
How This Compares to Industry Benchmarks
The Power Behind the Platform
Our next-generation claims management solution transforms how medical schemes operate by combining powerful automation with intelligent design:
1. Radical Cost Reduction
- Automated adjudication handles up to 90% of standard claims instantly
- Built-in validation rules prevent incorrect payments
- Cloud-based infrastructure eliminates expensive hardware costs
- Straight-through processing for clean claims
- Intelligent workflows route exceptions to the right team
- Real-time dashboards show processing status
- API-first integration with providers and partners using modern standards (FHIR, HL7, REST).
- Seamless support for legacy EDI transactions, ensuring smooth continuity where APIs are not yet in place.
- Self-service portals reduce call centre volumes
- Transparent claims tracking builds trust
- Faster payments improve provider relationships
2. Unmatched Efficiency
3. Member and Provider Satisfaction
Smart Automation
Our rules-based engine automatically:
- Validates member eligibility
- Checks provider credentials
- Applies benefit rules
- Calculates payments
- Flags potential fraud
Intelligent Workflow Management
Complex claims are never lost in the system. Our workflow engine:
- Prioritise urgent cases
- Flags high-risk or high-value claims for review.
- Maintain complete audit trails
- Supports clinical and financial oversight at scheme level.
Implementation That Works For You
Every scheme is different — and we tailor implementation to your needs:
- Discovery & Planning: - Mapping your current environment.
- Phased Rollout - Minimising disruption to your operations
- Ongoing Support - Local Smartchoice specialists stay with you long after go-live.
Results you can Expect
Typical outcomes for schemes using our solution:
- 40-60% faster claims processing
- 30-50% reduction in administrative errors
- 25-35% lower operational costs
- 20+ point improvement in member satisfaction scores
Why Wait?
Every month you delay costs your scheme money and damages member relationships. Our team is ready to help you make the transition smoothly and successfully. Contact us today to start your claims management transformation.
Claims management is revolutionised by SCT's auto-adjudication, which uses advanced AI to handle claims quickly and precisely. It automatically approves, denies, or changes claims, saving money and avoiding human error. This breakthrough speeds up processes and guarantees accurate, timely claim decisions.
With advanced API integrations and full ICD-10 compliance, SCT’s platform enhances claims management and ensures an efficient, modern processing journey. The cycle is streamlined by automating claim data exchange, saving significant time and effort. SCT also guarantees strict adherence to the latest ICD-10 coding standards, ensuring accuracy, regulatory compliance, and improved claim quality across the South African healthcare landscape.
Through the use of cutting-edge customer relationship management tools, the SCT platform transforms client interaction and increases transparency and engagement. Members and providers have direct access to benefits information and real-time claims tracking, which boosts confidence and satisfaction in the claims management process. The user-friendly, seamless experience created by this cutting-edge technology also fosters stronger relationships and trust between clients and their healthcare management.
Using the most recent technological developments, SCT's platform provides a forward-thinking approach to claims management. Strict adherence to ICD-10 standards and automated EDI solutions guarantee not only speed and efficiency in processing but also complete regulatory compliance. SCT's dedication to innovation places it at the forefront of modernising healthcare claims, ensuring a smooth and compliant management experience.