Our Services
At BillCore, we provide comprehensive medical billing and administrative services designed to enhance the financial health of your practice. Our goal is to streamline processes, maximize revenue, and ensure compliance, allowing healthcare professionals to focus on delivering quality patient care.
Key Billing Services
Patient detail capturing
Collecting and verifying patient information to ensure accurate billing.
Coverage Verification
Confirming insurance coverage to avoid claim rejections.
Coverage Claims Submission
Submitting claims to medical aids for reimbursement of services.
This is the Coding and Compliance Support
Ensuring accurate coding and adherence to industry regulations.
Denials Management and Appeals
Addressing denied claims and handling appeals for proper reimbursement.
Payment Collection & Reconciliation
Managing patient and insurance payments and ensuring accurate records.
Our Billing & Administration Process
01
Daily Claim Management
- Patient data capturing.
- Billing optimization.
- Claims submission and rejection management.
- Claims reconciliation.
02
Daily Credit Control & Collection
We follow a structured collection strategy, when all our collection methods are exhausted. The hand over process are dealt with in a professional and respectful manner only with full consent and approval from the provider. We do use an outsourced debt collecting firm, providers will get a frequent update and will immediately be made aware.
- Follow-up on outstanding claims and payments via calls, SMS, emails, and demand letters.
- Medical scheme collections.
- Member-liable collections.
- Handovers when necessary.
03
Financial Reporting
- We provide customized reports that can be shared with your accountant.
- Age analysis.
- Audit trail.
- Cash flow report.
- VAT report.
- Transaction and income reports.
Service Overview
Billing and claim submission via Electronic Data Interchange (EDI) for efficiency. Flexible claim submission schedules (daily or weekly). Daily or weekly reconciliation of payments from medical aids, insurance, and private patients. Authorization support for in-patient treatment. Comprehensive compliance with industry regulations and security standards.
Included Services
Practice
Documents
- Customized letterheads and billing templates for a professional image.
Billing Structures Assistance
- Expert guidance on benefit pool payments to ensure accurate billing.
Registry
Support
- Assistance with Scheme, BHF, and DPA registration / updates.
- Access to scheme rates and benefits information.
Webdesk
Access
- Secure login credentials for patient validation and benefit checks through our trusted software provider, Altron.
Regulatory Updates
- Regular updates on coding rules and industry changes to ensure compliance.
Included Services
The use of these services will be discussed upon assessment, with a full practice analysis determining the individual practice's requirements and needs.
Real-Time Submission Switching
- Optional service available at an additional fee.
Software License Fee
- Separate cost for access to billing software.
Debt Collection and Recovery
- Partnered with CR Investigation for outstanding debt recovery.
- CR Investigations specializes in tracking and tracing services and is recommended for outstanding and uncollected debt that meets the specific criteria.
FAQ's
Does BillCore only collect from medical schemes?
No, we collect payments from:
- Medical schemes
- Medical insurance providers
- Funding organizations
- Private patients (local and international)
What types of claims and collections does BillCore handle?
- International patient claims and collections
- Workmen’s Compensation (WCA) claims (in-house & outsourced)
- Injury on Duty (IOD) claims (in-house & outsourced)
- Road Accident Fund (RAF) claims (in-house & outsourced)
How effective is BillCore in collecting outstanding payments?
We maintain a 95% collection rate when possible on outstanding debt. Our proactive follow-up ensures minimal write-offs, and any noncollectable debts are handled per practice requirements.
Can BillCore bill and manage collections at my preferred rates?
Yes, we manage collections and submissions at Scheme rates, PMB rates, or Custom-defined rates per practice requirements.
Data Security & Compliance POPIA Act & Cloud- Based Data Storage
We comply with the Protection of Personal Information Act (POPIA) to safeguard sensitive patient information. Our encrypted cloud-based storage ensures data security and confidentiality.
Pricing Structure
Our pricing is based on your practice's income, type, and specific needs ranging between 4% to 6% of actual monthly income.
- For practices with a monthly income between R10,000 and R60,000, a fixed monthly rate applies, determined after a personalized assessment and mutual agreement.
- For practices earning above R60,000 per month, a percentage-based rate will apply, on a sliding scale up to 6%.
- There is no joining, administrative, or assistance fees
A personalized assessment and detailed proposal will be provided within one business day.
Joining Requirements
Service Agreement
Formal agreement outlining the terms, expectations, and commitments.
Mutual Investment
An initial 12-month service agreement to establish a long-term partnership.