A holistic approach for the management of healthcare benefits
GlobeMed Gulf Healthcare Solutions is a Third-Party Administrator (TPA) in UAE. Following the requirements and practices in the market and using advanced 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 experiences 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 performance by proficiently managing drug utilization for both acute and chronic prescriptions 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 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 a variety of functionalities and the ability of real-time members’ data transfer through web-service integration.
- Network Management: covering all contractual, pricing and other 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 convenient dispensing of prescriptions at healthcare providers while maintaining a high level of control.
- Automated Pharmacy Rules Engine: prescriptions are checked against pharmacy and medical rules such as drug interactions, indications, etc. to automate pharmacy claims coverage decisions and patients' safety alerts and identify drug related discrepancies. The engine is equipped with extensive dictionaries including a clinical index for more than 6500 ingredients.
- Drug Utilization Management & Review: We offer comprehensive and advanced set of pharmacy and medical checks through our medical rules engine, ARC. The solution also captures policy and business-related controls such as financial limitations, over utilization, etc. It covers the end-to-end claim lifecycle.
- Reporting: providing comprehensive and detailed reports to help payers monitor their performance.
Pharmacy Specialized Services Programs
Better adherence to treatments. Enhanced cost containment. Improved patient safety.
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
Clinical Coding Training Program
In 2002, GlobeMed launched the Clinical Coding Training program in collaboration with the renowned Saint Joseph University, one of the most respected educational institutions in Lebanon and the region. The benefits of the coding training program became evident and hundreds of professionals from the private and public sectors have completed the training program.
Our Approach
The program is offered by competent certified medical coders allowing trainees to master medical coding skills, accommodating different variations of coding systems related to ICD-9-CM, ICD-10, ICD-10-AM, ACHI & CPT4.
It provides a balance between theory and practice through classroom lectures & e-learning platform i*School® with courses materials and hundreds of practical exercises.
Health Information Analysis Diploma Program
GlobeMed Group and the renowned Saint Joseph University have teamed up to offer students a tailored diploma program in Health Information Analysis. The online program, taught by a team of professors from USJ and GlobeMed, was first launched in October, 2020.
The diploma program, consisting of 20 credits, gives students the opportunity to acquire the necessary skills to transform data into meaningful information and make the most of data to assist their top management to make better informed decisions. It allows them to work at many institutions such as hospitals, laboratories, healthcare centers, polyclinics, research centers, ministries, insurance companies, etc.
Automated Cross-Border
GlobeMed’s Automated Cross-Border service, one of the first in the world, allows 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.
World-class 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 the resident insured members serviced by GlobeMed Gulf (UAE) with:
- 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.
