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Preferred Providers Networks - Different networks of healthcare providers are being set-up to be made available to the customers of the insurance companies working with GlobeMed Saudi. Contracts with hospitals, polyclinics, pharmacies, diagnostic centers and independent physicians are being executed on the basis of direct billing, preferred tariffs and discounts, as well as administrative and medical protocols to which healthcare providers will have to comply.
Admissions, Medical Review and Claims Handling - A 24/7 customer support center ensures pre-certification of all admissions on the basis of policy-defined benefits, medical necessity, and usual, reasonable and customary practices. Claims and patients' records are reviewed to reconcile declared admission parameters, actions implemented and services billed. These processes are computer-assisted, with interactive online expert system support tools verifying medical and technical eligibility of each transaction being processed.
Third Party Accounting - In its capacity of custodian of the claims processed through its system, GlobeMed Saudi will settle, on behalf of insurance companies, their dues to the preferred healthcare providers network; settlements, on the basis of separate bordereaux per insurance company, will be timely and in full compliance with financial agreements in place with each healthcare provider.
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