Performance Review

Topics covered

• SSM
• TWT
• Quality
• Last 6 months errors
• Last 6 months RCA
• Functional measures
• Operational efficiency
• Mentorships
• Reduction projects

SSM

• Downward trend
• Reached our all time low in June of 94.03%
• 6 month average of 100.6%

TWT

• Last 6 months have been inconsistent for simplified
• Based on system issues, higher volumes than forecasted
• The average for simplified has been 94.48%

QUALITY

• Last 6 months have been inconsistent
• The main impact has been from simplified
• The second largest contributor is specialized

Last 6 months errors

• Dependent/Patient incorrectly captured
• Payment indicator - not indicated
• Processed duplicate lines
• Service date - incorrectly captured
• ICD10 - codes incorrectly captured

Last 6 months RCA

• Juggling the volume and quality component
• Assisting in a pool you do not usually work in
• Focus and concentration
• Negligence and not using the GP method

Paper claims

• Our paper claims are reducing year on year
• QR codes volumes have increased over the last 6 months
• HP intervention strategy gains traction

Operational efficiency

• Our volumes are remaining constant at 370k claims per month
• Our headcount has been reducing year on year from 126 to 104.
• The cost of a claim moved from R5.99 to R4.57.

Projects on the go

• Claims boxes
• Medical Claims Assessing
• Bankmed and Glencore take-on
• QR code
• HP intervention strategy

Next 6 months

Focus Areas

• Quality in Simplified and Specialised
• Staff and TL Engagement
• 1 Project every 6 months
• Support other paper claim projects

Quality

• New daily DPMO dashboard
• Trend per day based on DPMO
• Trend per day based on errors made per TL
• Trend per day based on errors made per capturer

Quality interventions

• Trend the top 5 TL errors MTD and department Top 5
• Bring into DPMO coaching
• Buzz sessions with entire team to prevent others making the errors

Staff and TL Growth

• Claims workshops
• WFH capturer
• Product up skills
• Admin upskill
• IH upskill
• Claims TL Mentorships

Projects

• Support QR code
• HP intervention Strat
• Support Claims Boxes
• Review OCR potential

#Claims