Medical schemes directly impact your revenue, compliance exposure, patient satisfaction, and operational efficiency. If your practice does not fully understand how medical aids operate, you are operating at financial risk. This course is available in three specialised editions, tailored to your role.
Strategic Oversight | Risk Management | Revenue Protection
Designed for Practice Owners and Directors who require high-level understanding of medical schemes, regulatory compliance, and financial exposure.
What You Will Gain:
• Clear understanding of the medical schemes industry landscape
• Insight into the Medical Schemes Act and regulatory framework
• Deep understanding of Prescribed Minimum Benefits (PMBs)
• Risk and financial management principles within schemes
• Understanding contribution trends and industry sustainability
• Oversight of claims adjudication and dispute resolution systems
• Strategic approach to preventing revenue leakage
This edition strengthens your ability to:
✔ Protect your practice against financial losses
✔ Make informed operational decisions
✔ Improve compliance awareness
✔ Lead your team with confidence
Operational Control | Claims Oversight | Compliance Management
Designed for Practice Managers and Senior Administrators responsible for day-to-day medical aid interactions and workflow supervision.
What You Will Learn:
• Structure and design of medical aid plans
• Detailed PMB interpretation and application
• Claim submission and administration processes
• Claims adjudication systems
• Complaint and dispute resolution processes
• Role of administrators and scheme processes
• Analysing complex claims
• Scenario planning and industry trend awareness
This edition equips managers to:
✔ Reduce rejected and partially paid claims
✔ Improve PMB approvals
✔ Strengthen internal systems
✔ Supervise billing and credit control effectively
✔ Manage disputes professionally.
Billing Intelligence | Dispute Management | Revenue Recovery
Designed specifically for Credit Controllers, Billing Clerks and Accounts Teams.
This practical edition focuses on improving collections and reducing write-offs.
Focus Areas:
• Understanding medical aid product structures
• PMBs and their impact on payments
• Claim submission processes
• Claims adjudication outcomes
• Dispute escalation and complaint procedures
• Financial risk and shortfall management
Includes real dispute case studies to strengthen:
✔ Claim follow-ups
✔ Motivation writing
✔ Shortfall recovery strategies
✔ Payment reconciliation
✔ Escalation processes