In this guide, we will unpack the guidelines and information necessary for the effective management of our provider networks across 51 African countries. Our processes include provider contracting, tariff negotiations, education, claims management, client communication, and accreditation.

Provider Contracting

Provider contracting is a vital aspect of our network management strategy. We directly contract with providers to ensure seamless healthcare delivery to our clients. Our provider contracting process involves the following:

• Identification and selection of quality healthcare providers.
• Negotiation of favourable terms and tariffs on behalf of our clients.
• Development of tailored tariff structures for improved comparability and cost control.

Provider Tariff Negotiations

Our negotiation process is designed to secure competitive tariffs for our clients. Key points include:

• Leveraging our pooled volume of activity to negotiate better tariffs.
• Implementing a tailored tariff structure for improved cost analysis and control.

Provider Education

We prioritise provider education to ensure understanding and compliance with our requirements. Education includes:

• Regular in-person meetings with regional network managers.
• Training on client policies, operational processes, and contact details.
• Provision of MSO International stickers for member recognition in provider reception areas.

Provider Web-Portal

Our web portal offers real-time functionality for providers, including:

• Member eligibility checks.
• Benefit availability verification.
• Claims submission and tracking.

Claims Collection & Forwarding

We offer flexible solutions for claims submission, including:

• Electronic submission via EDI capability or integration with Health Management Information System (HMIS).
• Manual submission via email for providers without HMIS.

Claims and Payment Reconciliations

We actively manage claims to ensure completeness and correctness, including:

• Resubmission process for incomplete claims.
• Resolution of payment disputes between MSO International and providers.

For further assistance or inquiries, please get in touch with our support team.