TGI CareNet is a healthcare Real Time Claims Processing and Settlement (RTCPS) system provided by Tres Groupe International. The system consists of three components, the Smartcard, Smart POS Machine, and the Backend System for processing claims.
The Smart Card
The TGI Smart card is an EMV card embedded with a microchip as well as the traditional magnetic stripe plus Near Field Communication (NFC) technology. The chip encrypts information to increase data security for members when transacting, making it nearly impossible for fraudsters to duplicate or clone the membership card…
The Smart POS Machine
The Smart POS Machines are deployed to medical service providers at no cost. These form part of TGI investment in the market. The POS Machines are biometric enabled with a fingerprint reader, iris scanner and facial recognition technology…
Value Proposition to Stakeholders
To the Government
- Improves effectiveness in tracking private health insurance contribution to Total Health Expenditure and the extent of contribution to financial protection. Availability of comprehensive expenditure information would reveal underlying trends and issues and allow for better informed decisions on feasible options to scale up public investment in this area.
- Improves acceptance of fee for service models in the healthcare sector – medical aid card acceptance.
- Monitoring, data collection and evaluation of the private sector activities ensuring credibility in reporting. Improved data on non-government healthcare provision and healthcare spending would help to provide a more comprehensive picture of overall healthcare provision and financing.
- Effective implementation of health policies and programs through RTCPS providing real time monitoring, and reporting frameworks. Government shall have the ability to conduct health services costing by levels of health care to determine cost-effective health interventions at an affordable price
To the Medical Aid Funds/ Societies and In-House Corporate Funds
- Reduce claims severity and ratios through negotiated cash tariffs and elimination of forward pricing
- Reduce OPEX and enhance solvency management through automated RTCPS
- Introduce efficient debtors’ management and reduce fragmented pooling.
- Liquidity and solvency structured bailouts through our partner bank for efficient management of public funds and financial protection of members
- Significantly reduce Out of Pocket Expenses in private healthcare, thus improving relevance of medical aid funds.
- Enhance capacity for new products and services, therefore increasing health insurance coverage through the smart card and competitive cost of health.
To the Medical Service Providers
- Elimination of paper claims and associated administration costs such as Claim delivery/ messenger costs, Stationary costs
- No risk of lost claims
- Reduction of telephone bills as authorizations are instant on the Smart POS Machine.
- Remittances available on demand via the E-Portal or Smart POS Machine
- Instant payment for services rendered and improved cashflow management for the facility
- Instant Membership and benefits verification via the Smart POS machine
- Instant claims reconciliations
- Access to the “Provider near me” facility on the TGI Mobile Application and Website. Members can easily locate service providers.
- Access to business and personal development loans via our partner bank
- The solution is offered at no cost to the service provider. No monthly fees, No administration fees
Partners
