In addition to insurance solutions, ASCOMA is operating since 2003, a healthcare division, the PACTILIS. The expertise provided by these partnerships gives our clients the widest possible range of health services. Simplified access to healthcare thanks to a large third-party healthcare network, along with constant advice and technical assistance, audit, analysis and monitoring of healthcare plans constituting a panel of services unique in the African insurance market.
Healthcare cost management
Groupe ASCOMA takes into account issues related to healthcare systems on the African continent. Therefore, we offer innovative solutions in partnership with local insurance companies.
Aware of the company’s health concerns, ASCOMA has set up an ASCOMA Healthcare division (the PACTILIS network) that allows companies to offer their employees a mutual fund. The access to healthcare through a better management of healthcare costs is to date unique in sub-Saharan Africa. Its services include access to a third-party payment system (no advance fees for beneficiaries, no management of reimbursement files for companies), an approved network of medical providers equipped with a dedicated and computerized reception allowing access to care for all, in addition to advice and technical assistance available at all times, and an audit, analysis and monitoring of health plans. It should be noted that the agreed rates are granted by the health structures accredited in our network, allowing a significant reduction in costs and a better control of the healthcare plans budget.
Travel while being insured
ASCOMA gives its members an international card with a barcode that can be read by an optical scanner to verify the patient’s eligibility to benefit from the third-party payment system. This card, which is particularly useful for insured persons who have to travel regularly, is valid abroad in the event of hospitalization or outpatient care under the same conditions as those of the country of residence. Only ASCOMA offers this service in Africa.
In order to avoid identity theft and prevent third-party payment access to uninsured persons, ASCOMA offers access to the ASCOMA Health database in real time. In this way, health care providers can instantly verify the applicant’s status as a beneficiary. Access to the ASCOMA health database also makes it possible to read in real time the coverage and exclusions of the plan. In a growing number of countries, the system identifying and managing claims is carried out using a biometric framework for enhanced security.
Control of healthcare costs
– Verify the coverage of insured patients in healthcare centers
– Regular visits to all hospitalized insured patients
– Automatic control of all invoices
– Request for informed consent for certain medical procedures
– Establishment of fee schedules for each medical procedure with medical providers and insurers.
This is the best solution to provide superior monitoring and better protection suitable for all.
Efficient analysis tools
Specialist tools enable clients to control their healthcare costs effectively by preventing overuse, over-prescription, fraud and overcharging.
– Standard or tailored periodic statistics make it possible to analyze the status of services and beneficiaries, college, ailments, geographical areas, beneficiaries or families by healthcare centers and providers.
– Expenditure analysis meetings are organized within companies to analyze the results of the plan and to reflect, if necessary, on the corrections and changes to be made.