What is the switch? Why do you need it?

eClaims switching is the process whereby medical claims are delivered electronically to their destinations.  In the same way that you need a mailserver to deliver your emails, eClaims switching requires a switch.  However - unlike email - eClaims switching involves a lot more complexity and value-added services.

Switching is a service that requires attention to detail.  Consequently, there are good switches and bad switches.  Panacea makes use of Datamax for it's switching services.  Datamax has been switching eClaims since 1995, so it has built up a wealth of knowledge and experience in the field.  Datamax's switch has been improved and refined for over 21 years.  It now provides unparallelled levels of service.

Why use Datamax Switch?

Access restrictions
Both the service provider (you) and the eClaims Destination (e.g. medical aid) have a relationship with Datamax.  This means the system is closed and secure and cannot be abused by illegitimate third parties.  It also means that it is easier to resolve disputes between the service provider and the funder.

Security
Data is encrypted to ensure the privacy of your sensitive data.

Tight Control
Datamax has dedicated staff whose sole purpose is to carry out procedures and audits to ensure that all eClaims are delivered and processed correctly and timeously.

Validation
Datamax ensures that your eClaims have all the required information and that they are accurate.

Verification
Datamax checks your eClaims against medical aid membership databases to ensure that they are accurate.

Routing
Routing of claims is not as simple as delivering to the eClaims Destination you chose.  Many medical aids require claims to be routed according to a complex set of rules.  For example, the patient's medical aid plan may require the claim to be routed to Primecure if the service is rendered out of hospital.  The medicine and material portion of the eClaim may be administered by a different administator requiring Datamax to split the eClaim.  When a medical aid changes administrator Datamax may need to split eClaims (according to service date) between the old and the new administrator.  You don't need to worry about any of this complexity.  Datamax's sophisticated routing system will take care of it.

Formats
The various eClaims Destinations require a plethora of different formats.  You don't need to worry about this at all.

Guarantee of delivery
The switch can issue you with a certificate proving delivery.  This makes disputes with the eClaims destination easier to handle.

Support
The switch can assist with many eClaims related queries and is able to liaise with the eClaims Destination (e.g. medical aid) using our own well established contacts.