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Funder Relations |
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Funder Relations & Contracting
This head office department is the Medi-Clinic group link with medical schemes,
insurers and other financiers at senior level. It encompasses various
functions, namely funder relations, case management and patient administration
and is led by Roly Buys, Director: Funder Relations & Contracting.
Every funder is allocated a Funder Relations Manager
who acts as the predominant link to each scheme/insurer/financier The current
Funder Relations Managers are:
If you require details of which Funder Relations Manager is allocated to your
scheme, kindly use the lookup table provided via this link (
Funder Relations Managers ).
Interaction with Medical Funders
During the past 2 to 3 years, the tariff contracting
environment within healthcare has changed significantly. Previously annual
hospital tariff increases were negotiated between the Hospital Association of
South Africa and the Board of Healthcare Funders, setting guidelines for the
tariff charged, however the Competition Commission of South Africa recently
ruled that private hospitals, and other healthcare providers, should set their
own tariffs and not be subject to pricing guidelines. This is as a result of
the setting of guidelines being construed as price-fixing and thus
anti-competitive activity in terms of the Competitions Act.
As a consequence, the Funder Relations &
Contracting department of Medi-Clinic has been negotiating individual tariffs
with medical schemes since 2002. We are committed to working together with
healthcare funders to provide cost-effective, quality healthcare and are
involved in a number of endeavours with a variety of funders both nationally
and internationally.
We have partnered with various funders to develop a
more sustainable tariff mechanism outside of the existing Fee-for-Service
structure by means of alternative reimbursement tariffs, including Per Diems
and Fixed Fees. Medi-Clinic implemented EDI (Electronic Data Interchange) more
than 2 years ago and we remain committed to business to business electronic
commerce where efficiencies can by gained by all parties.
Medi-Clinic is able to monitor on an ongoing basis
the impact of new technology, changes in case mix and different methods of
treatment with a view to facilitating the process of information exchange with
funders at all levels. In the process there is a move to a more streamlined
approach where our healthcare delivery matches scheme/funder needs. We believe
that we are in an ideal position to assist funders in understanding the unique
aspects of South African hospital care and are committed to providing quality
healthcare in the South African context, keeping in mind the changing face of
healthcare worldwide.
Interaction with Medical Funders facilitates:
pre-authorisation and re-authorisation
Contact us
Medi-Clinic Funder Relations & Contracting
1st Floor
Willie van Schoor Drive
Tijgerpark I
Bellville
7530
P O Box 3948
Tygervalley
7536
Tel no. +27+21+9436000
Fax no. +27+21+9436070
Contact Hester Conradie or the relevant Funder Relations &
Contracting Managers
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