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 in association with is offered to
Customers and may be integrated into other loyalty programs of
Customers.
SHS identify members where triggers exist for dental
educational events and such members 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.
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.
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.
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.