A Holistic Approach for the Management of Healthcare Benefits
GlobeMed Qatar is the leading and most trusted Third Party Administrator (TPA) in Qatar. Following industry best practices and using advanced technology solutions, our specialized professionals will support payers to effectively manage their 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 prescription drugs. It also promotes patient’s safety through real-time alerts related to their specific medical conditions. The advanced solution digitizes the pharmacy claims processing and can be offered as a 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
- Product Configuration: with highly flexible benefits plans design capabilities.
- Insured Members' Administration: with the ability of real-time members' data transfer through web-service integration.
- Network Management: covering all contractual, pricing and credentialing aspects of the providers' agreements.
- E-Prescription: digitizing the pre-processing of doctor’s prescriptions to improve the patient’s experience and reduce the potential source of fraud.
- E-Dispensing: allowing automated and convenient dispensing of prescriptions at the 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.
Generic Substitution
Based on the coverage policy, directing client’s insured members to less expensive but equally effective medications with automated calculation of copayments.
Automated Cross-border
Allowing insured members to use their insurance card at any contracted healthcare provider in various countries where GlobeMed operates in the MENA region, to receive their medical services and medications. The service is highly automated generating instant coverage decisions based on the members’ policy details.
Customer care
Exceptional multi-lingual call center providing 24/7 service support
Automated Cross-Border
GlobeMed’s Automated Cross-Border service, one of the first in the world, allows your insured member to use their insurance card to access medical service providers in various countries where GlobeMed has contracted networks of healthcare providers. The service is highly automated generating instant coverage decisions for outpatient claims based on the members’ policy details.
Insured members will receive entirely hassle-free healthcare services upon the simple presentation of their access card at more than 24,000 contracted GlobeMed healthcare providers in the MENA region.
International and Regional Servicing
With a proven track record of service excellence, GlobeMed provides world-class international health services to your members around the globe:
Access to healthcare provider network
GlobeMed offers your members access to the widest directly contracted network in the MENA region with over 24,000 providers, in addition to 120,000+ healthcare providers worldwide while securing cashless access and best tariffs.
Claims management services
Our comprehensive claims management services include securing claims pre-authorization, guarantee of payment (GOP), concurrent review for in-patient, discharge planning, claims adjudication and settlements.
Services to insured members
We believe that every interaction with your members is an opportunity to show them that we care. Hence, we continuously invest in our customer services, providing your members with:
- Field offices in hospitals with high traffic in countries where applicable, to be closer to members and better serve them
- 24/7 multilingual call center & SMS notifications for coverage decisions
- Insurance self-service tool through GlobeMed FIT mobile app
Additional Services
- Centralized account management services and reporting.
- Medical assistance services such as emergency medical evacuation, repatriation of mortal remains, etc.
- Facilitating insurance fronting arrangements with insurance companies when needed to meet regulatory compliance.
Actuarial Services
We have always embraced the scientific approach to managing healthcare. In this spirit, we provide our clients with actuarial services through our franchisor, GlobeMed Group, 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.
