This course is designed as a as a foundation course intended specifically for all people who require medical scheme industry, administrative, managed healthcare and medical coding knowledge working for a Medical Scheme Administrator or Managed Care Company.
It will also be useful as a bridging course for learners with medical and paramedical qualifications who wish to move into administrative positions in Healthcare Benefits Administration and managed care like case managers or disease managers, and for learners in call or service centres that are required to respond to queries regarding medical schemes and their products.
Who is the course intended for?
This course is intended specifically for Medical Claims Assessors and for people who require industry, administrative and medical knowledge in order to assess medical claims or to give advice on medical claims assessment decisions in a Medical Scheme Administrator.
Topic Covered in the course:
- Healthcare cover in Botswana
- The control of fraud in Health Care Benefit Administration
- The medical schemes administration subsector in Botswana
- Managed care as it applied in medical scheme administration in Botswana
- The use of coding in health care benefit Administration
- Diagnostic coding – ICD10 coding
- Procedural coding – CTP codes
- Consumable coding – NAPPI codes
- The cycle of a medical claim
- Assess a medical claim