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EDI Claims


    EDI (Electronic Data Interchange)

  1. This platform has been used in Zimbabwe for years. It links the provider with multiple medical aid societies. This greatly increases providers' support for the society and will definitely lower shortfalling. We like to emphasize that this is the only functional such platform in Zimbabwe and is very much tried and tested. We would like The Funder to take advantage of this platform right away. It can also be used to fine-tune the society's packages and Aid model through business intelligence functions.

  2. EDI (Electronic Data Interchange) features in the system include.

  3. Member File Bulk Upload:

  4. Only specific column headings are to be used.

  5. Each file would contain members on the same scheme AND plan, not a mixture.

  6. An error report is displayed while loading is occurring.

  7. Entire file’s content can always be traced back to this file and can all be deleted in one command as a batch.

    Member Details Update File Upload

  1. Only specific column headings are to be used.

  2. An existing system identifier (e.g member # and suffix, employment number) must be used.

    Claims Batch File Upload.

  1. A special file format has been developed and distributed to providers.

  2. A log is generated while a file is being loaded, which shows the activity and any errors.

  3. Only compliant 3rd party software can produce the file.

  4. A stand-alone encryption program is provided to providers who are using non-OmniSol software for managing their claims and billing records.

  5. A feedback file is generated, which is sent back to the provider for their own reconciliation within their own system.

    Medical/Clinical Notes.

  1. This feature can be utilized in conjunction with providers who have higher-compatibility software for EDI (Electronic Data Interchange) and typically with corresponding consent agreements with the patients themselves. This is because it enables detailed clinical information to be submitted about the patient. This is over and above mere billing/financial data.

  2. An unlimited number of details can be so captured under different categories.

  3. Data field types supported are text, numeric and drop-down

    Funders table - members of AHFoZ

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