FAQ

Upon submission of the claim the patient will be notified via SMS or email that a claim was submitted to their medical scheme on behalf of the service provider, the member is immediately aware of the claim. Once the payment is received from the medical aid the patient will receive an updated statement, should the patient be liable for any shortfall on the account the patient will be requested to make a payment. *A suitable payment arrangement can be entered into or the claim will be submitted to Gap-Cover (should the patient have Gap-Cover) Should the claim be a valid PMB the scheme will be contacted and requested to process the account at PMB rates. Prior to each medical scheme payment run a follow-up to the scheme will be done to ensure the PMB claims are in processing for payment.

We can manage collections as per your practice structure – at, below or above scheme rates or PMB*. *Providing the claim is a valid PMB with valid PMB ICD10 code/s and the authorisation loaded (by the hospital) as a valid PMB.

At Forte Medical we check claims before submission so they are captured correctly and submitted on time. Membership and dependant codes will be verified with the medical scheme prior to capturing of a claim. Should the claim be rejected for any reason (a daily report will indicate rejected claims), then these claims will be resubmitted to the medical scheme.

Yes – we do require each practitioner to sign a contract that defines the relationship and expectations.

No, there are no hidden costs and no annual increases. Fees are quoted per practice, as a percentage of what is actually collected.

Yes – A dedicated account administrator that has extensive knowledge of your codes and procedures will be appointed to your practice. Our service gives you a whole team of professional staff checking that your claims are processed accurately.

Claims reach us electronically from your practice, and we capture and submit them to the medical schemes electronically (EDI).

An End-of-day report from our switching house, on-demand reports and month-end reports are provided. You will always be in the know with regards to claims submitted versus payments received.