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You will receive a certificate on completion of the course.
An online learning platform to support all learners and motivate engagement.
An online platform that guides learners through all learning content and assessments.
Online tutors who are subject experts and we maintain human interaction and support throughout the learning journey.
Our modules include:
Assess a Medical Claim – R1750.00
This module is intended for medical claims assessors and learners in service centres who are required to respond to queries about medical claims. It requires learners to use insight in applying medical knowledge to process a medical claim.
The qualifying learner is capable of:
- Using medical reference guides to access information.
- Explain how scheme rules apply to the payment of a claim.
- Investigate the most commonly occurring medical conditions in South Africa.
- Explain basic terminology relating to medical claims.
- Process a medical claim.
The typical scope of this module is:
- Current codes include procedural, diagnostic and consumable codes and related tariffs/guidelines.
- Irregularities in a claim include, but are not limited to, procedures by gender and age, exceptionally high claims, cosmetic claims, anaesthetics, over servicing and over utilisation.
- User rights and confidentiality relate to information, staff, information on medical conditions and membership status.
- Conditions applied to Prescribed Minimum Benefits refer to service providers and medication.
Explain the Cycle of a Medical Claim – R1250.00
This module is intended for learners who assess medical claims. It will be useful for intermediaries and service centre agents in Healthcare Benefits Administration.
The qualifying learner is capable of:
- Explaining the origin of medical scheme claims.
- Describing the different routes followed by medical claims.
- Analysing a complex medical claim.
- Investigate the storage and retrieval of claims related documents in a Healthcare Benefits.
Complex claims include, but are not limited to, MVA, ex gratia, foreign claims and special cases such as orthodontic, oncology, trauma and HIV/AIDS.
Control measures include, but are not limited to, the Medical Schemes Act, Scheme Rules, options and limitations of benefits.
Utilise Clinical Coding Terms, Rules and Conventions for Diagnostic and Procedure Codes – R1950.00
The skills, values and knowledge reflected in this module is required by people in the field of diagnostic and procedural coding. Learners would be able to contribute to quality data in diagnostic and procedural coding by utilising terms, rules and conventions for ICD and procedural coding.
- Extrapolate the applicable clinical coding terms, rules and conventions for the interpretation of the relevant ICD and Procedure Codes.
- Explain the rationale of the applicability of Clinical Coding terms, rules and conventions for the assignment of the relevant ICD and Procedure Codes.
- Apply different applicable Clinical Coding terms, rules and conventions when assigning ICD and Procedure Codes, the Medical Schemes Act, Scheme Rules, options and limitations of benefits.
Analyse Clinical Information and Assign ICD and Procedure Codes – R2150
The skills, values and knowledge reflected in this module is required by people in the field of diagnostic and procedural coding. Learners would be able to contribute to provide quality services in diagnostic and procedural coding by analysing clinical information and assigning ICD and Procedure Codes.
- Assign accurate ICD and Procedure Codes to health and data records.
- Assess the impact of assigning inaccurate ICD and Procedure Codes.
- Apply rules, conventions and medical terminology when assigning ICD and Procedure Codes.
*Clinical information includes and is not limited to health records, medical reports, and medical terminology.
Introduction to Billing & Coding (Opthalmologists) – R500.00
Introduction to Billing & Coding (Paediatricians) – R500.00
Introduction to Billing & Coding (Cardiothoracic Surgeons) – R500.00
Introduction to Billing & Coding (Cardiologists) – R500.00
We specialize in training, upskilling and educating the Healthcare Industry.
If you have any enquiries, let us know how we can help you.
021 945 1881