Actuarial Services
We have always embraced the scientific approach to managing healthcare. In this spirit, we provide our clients with actuarial services, offering a range of specialized services through a dedicated team of qualified and certified actuaries. These include:
- Product design
- Ratemaking
- Reinsurance support
- Actuarial monitoring and reporting
- Early warning systems
- And health-related studies and bulletins
- Etc.
A holistic approach for the management of healthcare benefits
MHCMC is the leading and most trusted Third Party Administrator (TPA) in Syria. Following industry best practices and using advanced art technology solutions, our specialized professionals will support payers to effectively manage Healthcare benefits portfolio. Our aim is to build a lasting partnership achieving:
- Better cost containment through preferential tariffs and enhanced claims management.
- Operational efficiency by digitizing, automating, and optimizing workflows and business processes.
- Superior member experience offering quicker service.
Superior Customer Journey with Best-in-Class Cost Containment Measures
Pharmacy Benefits Management services (PBM) is designed to improve both insured members journey and payers financial and clinical performance by proficiently managing drug utilization for both acute and chronic prescriptions drugs. It also promotes patients safety through real-time alerts related to their specific medical conditions. The advanced solution digitizes the pharmacy claims processing and can be offered as standalone service or as an integrated module under the full healthcare benefits management services.
Pharmacy Benefits Management System Components
Digitizing the end-to-end pharmacy claims management cycle
- Network Management: covering all contractual, pricing, and credentialing aspects of the provider's agreements.
- E-Prescription: digitizing the pre-processing of doctors' prescriptions to improve the patient's experience and reduce the potential source of fraud.
- E-Dispensing: allowing automated and convenient dispensing of prescriptions to healthcare providers.
- Automated Pharmacy Rules Engine: a wide array of pharmacy rules to automate claims coverage, patient safety alerts, flagging drug-related discrepancies, and enabling the automated adjudication of claims.
- Mapping Capabilities: encompassing the mapping of the registered Human Drug List and Herbal Drug list to SFDA codes and NPHIES codes, thus enabling the proper activation of the automated pharmacy expert rules engine.
- Drug Utilization Review & Reporting: providing a comprehensive understanding of prescription cost and utilization drivers for better monitoring. In addition to standard reporting and BI tools with drill-down capabilities to design tailor-made studies.
Pharmacy Specialized Services Programs
Better adherence to treatments. Enhanced cost containment. Improved patient safety.
we deliver chronic drug prescriptions to the doorstep thus cutting the queue and wait time at the pharmacy
Generic Substitution
Based on the coverage policy, directing clients insured members to less expensive but equally effective medications with automated calculation of copayments.
