Excello Health
Health Care in Pretoria

A detailed list of all the current Excello Health products and services offered in South Africa.

Below you will find a list of the various services we offer. You will have the option to make use of a single service or combine services to enhance your current products. By utilising our unique set of protocols, claims received are thoroughly checked and discrepancies such as mismatch of laboratory codes to dental claims, age restrictions, incorrect use of tooth number, linking of ICD10 codes to clinical codes and many others are identified and can be acted upon. The Capitation Model ensures that a health care provider receive a fixed sum per patient from the customer, in return for a pre-determined level of services. This allows for providers to retain patients on a long term basis, managing their care as opposed to just providing a service to patients when needed. This model limits financial variables for both the scheme and provider. We have developed and maintain an in-house software package called iTooth that allows us to not only administer claims but manage the claims, gather claims data and ultimately report on our findings. The benefits in pre-authorising treatment are crucial to ensuring savings for the scheme and its members. We have taken pre-authorisation to the next level; by actually running the quote provided by a provider through our systems, we can provide the scheme with a detailed analysis of how the claims would pay at the time inquired. This pre-authorisation will include the application of our unique clinical protocols. Reporting back to the customer is a major facet of our business and we take pride in presenting our customers with detailed and professional reports. These reports consisting or tables and graphs indicating trends, summaries of findings and our recommendations are key in managing the various products owned by our customers. Every member of the scheme they belong to receives a list of contracted providers within their geographical areas whom they can visit for medical attention. When members use the health services of these doctors in their provider network, members are keeping the costs low for themselves and the scheme. The providers within the network provide services at rates negotiated with the scheme in exchange for their member’s visits. As an incentive to stay in the network for care, the scheme provides higher benefits, which lowers the out-of-pocket expenses for the members. We have at our exposure the capacity to run a fully automated call centre to handle incoming as well as outgoing queries. Some of our clients have a specific need to refer their members to network providers or specialists within a set framework. We understand this need and incorporated in our call centre-capabilities is an option to run a referral centers. This process saves our customers time on queries and allows for speedy completion of the claims process.