Products and Services

Products

We offer flexible and comprehensive service-driven solutions designed to enhance the business efficiency of healthcare administrators.

This includes:

• Dental benefit design and benefits allocation in alignment with scheme rules.
  
  
• Provision of Dental Claims Algorithms (Assessment Rules).
  
  
• Performance Measurement of Dental Providers.
  
  
• Pre-authorisation for Specialised Dentistry, including Orthodontics, Crown and Bridgework and Dental Implants.
  
  
• Pre-authorisation for Dental Hospital Benefits.
  
  
• Call centre dental enquiries.
  
  
• We are capable to verify benefits on a line-item basis where benefits are limited or capped.
  
  
• Pre-authorisation and Benefit Verification responses are drafted on behalf of clients and are sent to clients by e-mail in a fax ready or e-mail ready format using a PDF format to maintain the security of the contents.
  
  
• A dental wellness program is offered to Customers and may be integrated into other loyalty programs of Customers.
  
  
• SHS identifies members where triggers exist for dental educational events and such member’s will receive educational and promotional material and/or gifts relevant to their oral health status.

SHS can offer different service models:

This is a complete outsourced approach.

Comprehensive Dental Risk Model

The scheme pays SHS on a per-member per month capitation fee basis and SHS together with its partners assume risk while providing comprehensive dental claims administration and risk management services.

Integrated Dental Risk Management Model

We work with partner medical scheme administrators who pursue an integrated offering to medical schemes. The scheme retains the risk, the administrator provides claims administration and SHS integrates its dental risk management processes into with the claims processes of the administrator.

Client Selection Model

The client may select a combination of services best suited to their needs. This approach would mostly be taken by self administrated schemes with limited scope of cover such as capitated primary care cover.