Lenasia Computer Services (LCS),
a bureau that initially managed accounts for 55 (fifty-five)
medical practices mainly General Practitioners, Dentists and
Anesthetists, approached RapidSoft in February 1999 with a project.
The objective of which initially was to convert from old Dbase
system to a state-of-the-art windows based solution, and replacing
the old QEDI interface with the EDIfact format interface through
FirstNet.
The first phase
commenced in February 1999. In June 1999, the new system was
successfully implemented, and full training was provided to
the data capturing staff and data administrator. In the next
phase, QEDI interface was successfully replaced by EDIfact
format FirstNet switch interface. Introduction of the new
interface to MedPrax’s Medicine, Injection and Materials
database, significantly tightened up the validation. It also
allowed for vast improvements from the previous functionality,
creating an effective, successful user-friendly environment.
Some of the key features of the system are:
Logging of each patients’ visits,
diagnosis, treatment, medication etc.
Matching the payments from the Remittance
advice to the invoices.
Interfaces with MEDPRAX for NAPPI codes
and latest Medicine and Consumables prices
Interfaces with various Medical Aid Schemes
(e.g. MedScheme, Discovery Health, BankMed, Old Mutual etc.)
transmitting Claims Data through Data switches such as FIRSTNET,
MEDISWITCH, MX Health and Cape Medical Plan, QEDI etc
Complete Transmission Log Maintained
Statistics by Doctor / Medicine / Treatment
Windows-Based
Network Compliant
The nature of LCS business has been changing
and expanding significantly since 2000 and RapidSoft has enthusiastically
met every challenge. Thus ensuring that their system remained
on par with their evolving business. LCS has constantly been
exploring the possibility of interfacing directly with the various
Medical Aid Administrators in order to speed up the turn around
time on settling of the Medical Aid claims. So far LCS has established
direct links with approximately 20 (twenty) different Administrators
and RapidSoft has provided the respective interfaces to LCS.
The Medical Aid industry has generally
been tightening up procedures in order to clamp down on fraudulent
claims, to this end they have adopted several international
standards. LCS commissioned RapidSoft to enhance the system
to cater for these standards. For example, in 2002 ICD Codes
were introduced, these are the International codes for Detail
Diagnosis of patients. It is becoming compulsory for all the
Practitioners to provide the relevant ICD code on each claim.
The capturing of data at LCS and the validation in the system
is of such a high standard that LCS has extremely good reputation
in the industry for the quality of their data. Hence a large
percentage of the claims submitted by LCS on behalf of their
practices are settled promptly.
In 2002, the Orthodontist practices were introduced
into the system. A further improvement to the system was made
that facilitated for specialized dental work to be settled
over a period of time, usually over a 24-month period.
Another important development that took place
in 2002 was when Health Bridge (a Medical Aid administrator
which handled approximately 1900 practices) approached LCS
to facilitate the claim processing of Sizwe (another Medical
Aid Administrator) data. RapidSoft achieved this by converting
Health Bridge’s Edifact format data to NSF format as
required by Sizwe. This interface has been in operation for
over a year. Since then several other Medical Aid Administrators
has shown interest in LCS in order to transmit data on their
behalf to various Medical Aids. Currently, we are testing
the interface with Habit Solutions who administer data for
several thousand Practices.
In October 2003, we introduced a query logging
and follow-up module in to the system. Currently, LCS is negotiating
with several Group Practices, and in the meantime RapidSoft
is exploring the ways and means to introduce these Group Practices
in to the system.
