Downloads - Providers

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Our Services

Our outstanding customer service is our differentiating factor that sets us apart from other TPA's. Our services are meant to satisfy the requirements of our clients, policy holders, as well as the healthcare providers. Any complaint, advice, or suggestion regarding our services is always welcome. We work tirelessly to create, maintain, and to continually improve an effective relationship with each and every client.

Our services:

	Clients (Self Funding Organizations and Insurance Companies)

	Policy holders / Members (Eligible Employees and their Dependents)

	Statistical and other Support Services to Clients


	Clients (Self Funding Organizations and Insurance Companies)

	Designing and managing tailored flexible, customized and cost effective health benefit plans and by the integrated implementation of these plans, we help our partners and clients to recognize their goals for savings and favorable outcome.
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	Providing healthcare Network for complete diagnostic and treatment services at significantly discounted rates.
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	Cashless/direct pay medical care through Almadallah's healthcare provider network.
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	Providing healthcare providers detailed instructions (manual) on how to provide the best customer service to our clients' employees and eligible dependents.
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	Issuing membership ID cards as per required specifications.
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	Providing health scheme/coverage guides to members/ policy holders.
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	Maintaining census of enrolled employees and their dependents.
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	Providing treatment and utilization reports, at any point of time, including information on claims, eligibility, enrollment as desired by the insurance company/self funding organization.
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	Utilization of state-of-the art information technology for fast, more accurate claim processing with significantly reduced claim turnaround time.
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	Disease and cost management: By coordinating, managing and closely monitoring of the member’s treatment, we combine cost management and disease management in an effective way.
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	Maintaining strict confidentiality on all aspects of member information.


	Members (Eligible Employees and their Dependents)

	Issuing membership guide providing vital information regarding the network of providers, health scheme details, etc.
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	Members can call our client service center to get information about our healthcare provider network, identifying appropriate specialists, locating nearest providers, their benefits, exclusions and claim status etc.
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	Periodic site meetings with members to update them on their health coverage, new healthcare providers, answer their queries, receive their re-imbursement claim forms, etc.
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	Providing assistance to members in filing a claim, in case the policy holder gets treated at a non-network provider.


	Statistical and other Support Services to Clients

	Periodic monitoring and reviews of the provider network are conducted for continuous improvement and maintenance of the quality of service provided
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	Provide claims management services including complete evaluation of all claims, data entry, etc.
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	Facilitating better control and monitoring of claims processes.
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	Reviewing health benefit plans, evaluating structure, scope, financial efficiency and cost effectiveness.
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	Organizing training programs on site for the benefit of staff and clients.
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	Medical data analysis and reporting.
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	Maintaining statistical records as required by the insurance company/self funding organization for understanding various issues and undertaking proactive decisions.
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	Generating periodic reports, which provide management tools for analysis and control of benefit costs.
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	Standard periodic reports on claims paid by group, most common claims, most frequently used healthcare facilities, customer service reports on various issues such as nature of calls received, etc.
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	Maintaining strict confidentiality on all aspects of member information.
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	End-of-policy group reporting on most common and most expensive claim illnesses/procedures, members with greatest number of services, benefits paid by type, etc.
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	Yearly portfolio reports on benefits paid, most commonly used healthcare facilities, benefits/services, age & sex distribution of the insured population, etc.

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