PRODUCTS & SERVICES




We offer the following packages of BPO products and services to its customers:

Type of BPO products Targeted customers Key features of the services
Third party administration ("TPA") Self-insured customers and/or insurance companies Actual
medical expenses are borne directly by corporate clients.
Fully insured programme Insured customers Medical
expenses are fully insured by an appointed licensed insurer.
Combination of TPA and insured programmes Combination of self-insured and insured customers TPA
services in relation to outpatient services and insured programme for inpatient
services.
Consultancy Corporate clients Advisory
work in areas related to Human Resource and Employee Benefits

In consideration of our management fee, our clients, either the corporate organisations or the insurance companies will enjoy the following 3 main services from us or known as MAP:

 

MEDICAL MANAGEMENT

This is the most important area of services to be provided by any healthcare management and administration or managed care organisation. Our medical team will ensure that medical management shall be an integral part of the services that we provide to its corporate clients. With a proven track record in managing 650,000 members as at today, we are able to provide the medical management in terms of quality assurance and benchmarking and preventive programs in either one or a combination of the following:

  • System driven - where a set of parameters are incorporated based on our experience having managed and administered since the last 18 years to process the medical claims that are submitted from the medical providers. Claims that breach the established parameters will be scrutinized in detail by our medical team
  • Retrospective case management - where the charges of medical treatment is checked and verified on the reasonableness of the charges based on the treatment provided by a particular medical provider. We will ensure that the charges are justifiable with the treatment provided by the medical provider based on the patient’s condition and the level of sophistication of the said treatment. Whenever we need to negotiate with the relevant medical provider, we will do so with the objective of having the medical charges reduced while maintaining the quality of medical delivery;
  • Proactive case management - although minimal intervention is exercised, we will advise the patient of all available options to the patient based on the patients benefit entitlement. The decision to choose whichever avenue of treatment will be at the sole discretion of the patient provided they are within the patients benefit entitlement. Further, once we have collated the relevant data for a certain period such as one year, we will design a relevant treatment program in the following year for relevant patients of selected diagnosis to follow in order to mitigate the condition of the patient not to deteriorate further. This includes a schedule of visits to the relevant medical specialty by the identified patients; and
  • Preventive program - whilst part of the program has been elaborated in the proactive case management, this program focus on providing the patient with useful information of their related illness and what are the dos and don'ts for them not to aggravate their conditions, or most importantly to prevent them from having at all. Immunisation for children is managed and administered systematically by us. The types of immunisation will be of those recommended by the Ministry of Health, Malaysia.
 

ADMINISTRATION SERVICES

The benefits of BPO amongst others include relieving corporate clients from performing non-core administrative functions while at the same time allowing them to focus on their strategic and core competencies and enhancing their companies’ values. The administrative services that we undertake to relieve the corporate clients, amongst others are as follows:

  • The 24-hours carelines - Our corporate clients are no longer required to facilitate their employees and eligible dependents to access to medical providers which can be troublesome if they happen to be on weekends or public holidays. We provide 24-hours carelines centre to facilitate admission and outpatient specialist visits of corporate clients employees and eligible dependents to medical providers on cashless basis. Our carelines centre also attend to queries by members on members validity, the benefit entitlement, the medical utilization incurred to date, the limit available, provider locations and other general enquiries.
  • Medical utilisation report- We generate for our corporate clients medical utilization report on periodical basis. The report contains qualitative and quantitative information such as information on medical expenses incurred by department, cost centre, subsidiary, division etc. depending on the organisation structure.The report also analyses the trends on the medical cost, utilisation, diagnosis, type of illness and recommendation to manage the medical cost. Therefore, this report can be very useful tool for the management of corporate clients to make informed decision.
  • Employee personal ledger - We maintain ledger for our corporate clients’ employee and their eligible dependents. The ledger has personal details of employees such as medical utilisation (i.e. where and when treatments were made), type of illness, benefit entitlement, etc.
  • Maintenance of eligibility listing - Every month or quarter, we provide to our corporate clients Eligibility Listing; on the names of employees and eligible dependents who are eligible under various benefit entitlements. The listing will also provide the latest updates on any staff movements and additional or termination of employees and eligible dependents.
  • Claims administration - Corporate Clients are no longer required to capture and process medical claims from the various medical providers which can be laborious and tedious. Instead, we capture and process all claims from medical providers on behalf of our corporate clients and make payments to the various medical providers accordingly.
 

PROVIDERS NETWORK MANAGEMENT

We have a strong network of affiliated medical providers located nationwide. As at today, we have 3,000 affiliated medical providers. All of the government hospitals and most of the private hospitals accept our members based on our confirmation of eligibility. Therefore, our corporate clients no longer need to worry about the recruitment and termination of medical providers as we undertake this duty. By placing the medical providers under the same umbrella, the corporate clients shall benefit from the following improvement:

  • Centralised claims submission - All completed claim forms are to be submitted to us instead of the individuals companies or insurance companies. From the medical providers point of view, this will be easier as they need to send only one statement of account instead of many individual invoices to all of the corporate clients or insurance companies. From the corporate clients perspective, they no longer need to process the various invoices from the medical providers as processing is done centrally at our office. From the insurance companies perspective, they will just need to approve or reject the claims that have been processed and submitted by us;
  • Standardised claims form - All medical providers will use a standardised format of claims form, depending on the type of services provided. With standardised claim forms, processing can be expedited and capturing of useful information is made easier. Hence, this allows useful reports to be generated for the clients; and
  • Centralised payments - We can also arrange for central payments. We have working arrangement with several banks to facilitate payments and collection process through MEPS-IBG or inter bank giro. Thus, our corporate clients only make one payment to us and we will distribute the payments directly to the various medical providers. This ensures easy control for clients and medical providers as the administration would be dealt with by a single contact.

In addition to the 3 main services, we also offer consultancy services for advisory works related to human resource and employees benefits.