More than 50 employees, under the excellent management of Maronel du Preez, run the vast engine room of Managed Healthcare at Bestmed: Hospital Benefit Management. The department successfully resolves numerous authorisations of specialist admissions, hospitalisation, case management and hospital claims daily.
New initiatives are also being developed and implemented, including a fast and automated authorisation system, a one-day turnover of all queries and complaints, and a streamlined problem case-solving procedure. Since Maronel’s appointment on 1 March 2020, the department has met all organisational targets.
Bestmed’s Information Technology (IT) service provider, 2Cana, is currently developing an automated authorisation system to be used by the Hospital Benefit Management team. A “quick authorisations” systems has already been developed, which entails a less complicated procedure. The department will no longer need to ask for motivation or other documentation before authorisation is given if all the requirements are already met. Once protocols are completed and necessary requirements implemented, this system may also become automated to create authorisations. This exciting, new development will also assist providers to load authorisations, especially after hours.
In order to manage a one-day turnover of all queries and complaints, employees’ expected key performance statistics were adjusted to implement the objective to complete ten enquiries per day. Same-day enquiry responses have been made possible since April 2019 and the team works hard to make sure that the enquiry bin is empty before each pay run.
Each agent has been empowered to make a positive contribution and a difference in members’ lives by going the extra mile, or even just listening. “Members will forget the words you say, but they will always remember the way you made them feel,” states Maronel. The amount of positive feedback received from Bestmed members is indicative that Maronel and her team have stood testament to our Personally Yours promise.
The past two months, according to Maronel, have been very challenging due to the outbreak of COVID-19 in South Africa. “I want to thank my Team Leaders for all their support and assistance. Without them, and every Heartbeat, HBM would not be able to reach the amazing service level of which we are so proud. I also want to thank Ina Erasmus, who is still showing me and teaching me such valuable content that she has learnt over the past 25 years that she has been in this position. I would also like to thank Prof. Jan for all his guidance and support. Last, but not least, to every Heartbeat in HBM who supports and encourages me – thank you. I have such remarkable employees in HBM, and each one is unique in their own way. I am extremely excited about what the future holds for HBM. I am honoured to be part of a team that goes the extra mile with an extra smile.”