Tariff Code Management

  • The Tariff codes system is used to identify treatment or service delivered by providers to members. It is a vital component of the whole Scheme Genius ecosystem.

  • The codes defined in the system are the only ones which the system will recognise and use for purposes of benefits adjudication and award.

  • Alphanumeric codes are used, they need not conform with other systems by other regulatory bodies, but those who submit claims must be familiar with them.

  • Each code has a flag (colour code – Green, Amber, Red) which is shown each time a user captures it.

  • Each code has a price and can optionally have a co-payment fixed.

  • Codes can be placed in ‘clash classes’ so that if 2 tariff codes are in the same ‘clash class’ then they cannot be on the same claim together.

  • A frequency class can be defined, so that frequency restriction rules can be applied to it (e.g max number of times per day, month, 6 months, 1 year, et.c).

  • A maximum quantity can be set.

  • Inpatient/Outpatient Restriction

    1. Not Specific
    2. In-Patient Only
    3. Out-Patient Only
    4. Whether pre-authorisation is required or not
    5. Hospital grade restriction
    6. Filtering out tariff codes without benefit allocation
    7. Adding service provider disciplines which can deliver/claim for the particular tariff code’s corresponding service(s)


  • The system can generate bills for all member for a specific period.

  • The bills can be generated going back into the past.

  • The system checks to ensure a member does not get 2 bills for the same month and produces corporate invoice.

  • The bill picks up and includes miscellaneous charges such as printed cards.

  • Mass-mailing of member bills, e-mail and SMS reminders.

  • Client statements (automated) and cash receipts.

  • Integration with accounting systems such as Pastel -(batch or real time) – our references for successful Pastel integrations can be supplied upon request.

  • Archiving and viewing of scanned documents against each member’s electronic file, with an emailing and printing option.

  • Scanned documents will be tagged to indicate their content and type.

  • Archiving and opening audio and video attachments to each member’s file.

  • Viewing member statement. This can be printed and/or emailed. The statement shows all the treatments and corresponding benefit allocations for all the dependants on a selected family.

  • Printing member confirmation letter.

  • Customizable data pages: this is a feature which enables an unlimited set of information about each member to be captured, with provision for different data types (text, numeric, drop-down).These can be customised without recourse to additional programming work.

  • Storage of banking details.

  • Storage of agent/commission contract details for each member – where applicable.

  • Receipting of individual member payment.

  • Generating billing statement per member.

  • Generating claiming statement per member.

  • An audit trail which shows every successive snapshot of a member record as changes are done over time. This cannot be edited or deleted.

  • Viewing a benefits summary which shows current usage levels for ALL the benefits which the member is eligible for at a given date.


  • Membership card generation, printing.

  • Integrated Billing for cards printed.

  • Card printer queue management.

  • System generates member numbers and suffixes.

  • Enable moving a dependant from one family to another, or to be a stand-alone.

  • All the claims that the member had will follow that particular member, regardless of changes in family or plan.

  • Old membership numbers retained.

  • Electronic remittance advise uploading.

  • Electronic claim status feedback uploading.

  • Genarations of Quotations, invoices, receipts….


    Users can search for members by



    1. Member number
    2. Old member number
    3. National ID
    4. Name, surname
    5. Employment number
    6. File/account number
    7. Additional dependants can be added using a file upload.
    8. New members can be added using a file upload
    9. Date-driven membership status design: The user does not have to calculate the actual member status (active, waiting period, etc.)
    10. The user only captures the events which occur to the membership according to instructions from the client and the system uses this to determine status at time of treatment.


  • Membership EventResultant Status
    Joined – RegularActive
    Terminated from PlanTerminated
    Joined – LateActive
    Terminated from FundTerminated
  • The system uses the table above for mapping and thus determining what status the member is in at a specific date. This is also dependant on the status of the principal member.A member is changed to another plan by capturing a ‘Joined’ event to the new plan.The system automatically calculates the waiting period depending on whether late-joiner or regular-joiner.

Member Data Configuration

  • This feature enables the system administrator to configure the custom data page of the member data file.

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

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

Member Tags

  • This feature enables management of the member tags. These tags distinguish the member and directs how the member is billed. The fundamental tags are:

  • Corporate.

  • Individual.

  • Student.

Membership Reports

  • The columns of membership reports are user-defined.


    The following filtering parameters are used for each report


    1. Fund.
    2. Current Status (Active, Suspended, Terminated, Black-listed).
    3. Date of Birth.
    4. Join-date.
    5. Principal Members only.
    6. Date captured.
    7. Last membership event.
    8. Card printing status.
    9. Record verification status.
    10. Account balance (plus, minus or zero).

Membership Movement Reports

  • This shows significance changes to the membership.

  • Columns are Join-Date, Activity, Effective-Date, Benefits Date.

  • You can filter by specific event types, or by fund.