Industry challenges
File volume
Thousands of Medicare claims and private health fund requests to process daily.
Prescription consistency
Do the billed medications match the prescriber's script?
Coverage verification
Verify patient Medicare eligibility and private health fund cover before each procedure.
Document fraud
Detection of falsified prescriptions and billing inconsistencies.
Documents processed
- —Medical prescriptions
- —Medicare claim forms
- —Medicare cards and private health insurance cards
- —Hospital invoices
- —Pre-authorisations
- —Medical reports
- —Admission forms
- —DVA (Department of Veterans' Affairs) entitlement cards
Automatic validations
- ✓Billed items = prescribed items on the script
- ✓Prescribing doctor registered with AHPRA (Australian Health Practitioner Regulation Agency)
- ✓Patient Medicare eligibility verified at date of service
- ✓Billed amount compliant with Medicare Benefits Schedule (MBS)
- ✓Date consistency between prescription and service
- ✓Patient identity verified across all documents
Measured results
85%
time saved
+25%
fraud detected
-45%
claims processing delay