Services

• We carry out the analysis and control of contributions from the perspective of their compliance with the Benefit Plan Covers, be it the Network of Agreed Providers or Insured parties or Users, controlling and verifying the invoices/receipts;
• We manage the returns and refusals of health expenses to the Insured Parties and Users or Groups and Companies;
• We are sending the extracts of “medical expense contribution” for Insured Parties and Users and for Health Care Providers;
• We configure, implement and monitor the parameters and indicators for use.

• We monitor and we proceed to the management of clinical cases;
• We carry out and monitor the process of pre-authorisations and issuing of clinical opinions;
• We support the management of the provider network, to wit in the contact with the providers;
• We coordinate an Advisory Medical Panel, supporting the interface with the medical community in the discussion of more complex clinical cases;
• We adapt the Clinical Guidelines and protocols to the Portuguese reality;
• We collaborate on the production of clinical items for the Newsletter;
• We develop Preventive Medicine programmes.

We manage a phone service centre for clarification of questions of Insured Parties and Users as well as the health care Providers, to wit:

• Questions related with the processing of the expenses;
• Integration of expenses into the respective Benefits Plan;
• Carrying out of eligibilities;
• Questions, comments and miscellaneous information.

• Taking advantage of the growing rate of use of the Internet, we commenced the development of a Portal which allows the access of Insured Parties and Users to their health information;
• The Portal is personalised with the institutional image of each Insurer or Subsystem.

• We ensure the measurement and analysis of Key Performance Indicators with respective reporting to our Institutional Clients, in such a way that these serve to support strategic and operational decision-making;
• We ensure the presentation of results relating to Satisfaction Surveys;
• We fully manage possible complaint processes, ensuring the periodic submission of Management Reports to our Institutional Clients.

• We carry out contracts with new Providers, bearing in mind the needs for expansion of the network in geographic terms and the evolution of the portfolio of Insured Parties and Users;
• We see to the establishment, management and negotiation of the fees’ tables protocoled;
• We develop market analysis processes (private and agreements), so as to ensure competitive pricing models;
• Desenvolvemos um plano de credenciação enquanto método rigoroso de selecção dos nossos parceiros, com o objectivo de garantir aos nossos Clientes a melhor qualidade e segurança na prestação dos cuidados de saúde
• We see to the maintenance of the network formed, endeavouring to maintain the quality levels of the services provided to the Insured Party or user.
• We have developed training/information actions to support the Providers.

• Access Cards for the Network at agreed prices

• Directories of Provider Network Consultation

• Newsletter - Health Care and Preventive Medicine

• Promotional Materials on the Provider Network