Insurers
International healthcare and insurance have evolved dramatically over the past decades given a strong growth in cross-border movement.
Medical providers often don’t have the resources available to understand the complexities of international claims healthcare and foreign insurance.
A variety of challenges hamper working relationships between the various stakeholders involved with international healthcare: the patient, the insurer, TPA’s, cost containment companies, medical providers and independent health professionals.
INTERNATIONAL HEALTHCARE CHALLANGES
Language Barriers
Many foreign providers don’t have staff who operate fluently in English, complicating communication.
Differing Systems
Differing administration processes can affect international healthcare, for example, sending invoices without service/product itemization. Errors in documentation delay claim processing, frustrating all parties involved and damaging commercial relationships.
Medical Rates
Foreign providers often use pricing tiers based on the payer of the bill - foreign payers often receive higher rates.
Policy Misunderstanding
A lack of understanding regarding verification of benefits, explanation of benefits, letters of authorization and guarantee of payments create claim processing complications.
Unnecessary Services
International healthcare can result in the execution of unnecessary diagnostic services.
“Amedical identified the need for an innovative service solution that facilitates understanding, communication, and competing interests between international healthcare stakeholders – we bridge the gap between insurers and medical providers in Latin America, guaranteeing positive outcomes for all parties involved: the insurer, the provider, and the patient.”
WE RESOLVE CRITICAL ISSUES FOR INSURERS WITH MEMBERS ABROAD
Balanced Facilitator & Intermediary
We simultaneously understand the requirements of our clients and the capabilities of our network.
We sit between the healthcare provider and the insurer, facilitating communication, correspondence and documentation.
Local Support
Our 24/7 back office service center work directly with the healthcare provider and the insurer.
From admission or treatment preparation, we work directly with the respective provider to expedite the claims process.
Preferential Rates
We have close relationships with all the providers in our network; as such, we have an in-depth understanding of fee structures and pricing tiers.
We ensure billing integrity and guarantee preferential rates to our clients, allowing for concrete savings on health and medical expenses.
Real-Time Access To Information
Our innovative platform ensures that PHI and financial information is communicated securely and in compliance with regulatory standards (HIPAA, GDPR etc.).
Our platform provides real time access to all relevant information for the relevant and authorized parties involved.
SIMPLIFY INTERNATIONAL INSURANCE CLAIMS
Our bi-lingual team provides the full suite of international insurance claim management services to compliment your billing department, including:
Claim reviews
Meticulous claim reviews - cross-reference services rendered with coverage, medical necessity, duplicate charges, date errors, etc.
Comprehensive audit
Every claim is audited, ensuring transparency and a fair outcome.
Billing and coding
Our claim team bills using updated US coding (UB-04, CPT, and ICD-10)
Claim processing
We can process medical claims using CMS 1500 and UB-04 forms.
Benefits Verification, GOP & EOB
We assist with VOBs, issuance of GOPs, sending out of claim forms, and sending finalized EOBs to providers and members.
Payments
We can make payments in local currency on the insurer’s behalf, facilitating the provision of cashless services.