Solutions

Offers payers the flexibility to effectively administer and manage members portfolio. Our system can automatically integrate with the payer’s system to provide the PBM service.

Allows the management of various formularies based on the insurance plan, policy or payer’s requirements. Payers can easily determine the drugs to cover per plan, medicine source, medicine family, and medicine ingredients.

Easily detects any fraudulent claim form through the prior assignment of specific serial numbers to specific providers on our system. Our PBM solution can easily detect whether a specific claim form is related to the healthcare provider whose signature and stamp are displayed on the form. 

We offer insured members access to a wide network of pharmacies including 1,017 pharmacies across Egypt. Our wide network is carefully selected abiding by a strict provider selection criterion based on the following factors:

• Geographic reach
• Specialty and service requirements in accordance with client’s needs
• Preferential tariff and discount

Furthermore, we ensure that the users at the pharmacies within GlobeMed network are well trained to use our online system to offer insured members hassle-free service. 

New and refill prescriptions are checked against clinical rules to automate pharmacy claims coverage decisions and identify drug-related discrepancies. Moreover, it can be customized based on payer’s preferences and needs. The engine is equipped with extensive dictionaries including a clinical index with more than 6,500 ingredients, automated clinical support for indications and contraindications, duplication, dosage adequacy, and alerts.

Allows the posting and dispensing of chronic prescriptions on monthly basis. Consequently, patients can dispense their medications monthly upon the simple presentation of their insurance card through a paperless process at a specific pharmacy or within the whole network without the need to renew prescriptions during the whole posting period.

Offer comprehensive understanding of prescription cost and utilization drivers with multiple drill down capabilities through our advanced Drug Utilization Review tool.

Offers the flexibility to set the out-patient benefits plans on the system and to accommodate any combination of benefits, conditions, and restrictions including limitations, co-payments, coinsurance, waiting period, and restricted network.

Offers payers the flexibility to effectively administer and manage members portfolio. It allows to capture members administration details including the current status of member i.e. active, inactive or deleted. It further enables to verify eligibility of benefits as set by payers.

Integrates with GlobeMed’s medical rules engine ARC to maximize the automation of coverage decisions and the end-to end claims processing.

Easily detects any fraudulent claim form through the prior assignment of specific serial numbers to specific providers on our system. Our OBM solution can easily detect whether a specific claim form is related to the healthcare provider whose signature and stamp are displayed on the form.

All technical aspects of the healthcare provider can be managed including tariffs, discounts, and other contractual obligations. GlobeMed Egypt also trains healthcare providers to directly access our online solution they use for instant claims adjudication, update and arrange their own prices and details online.

Allows healthcare providers to process claims requests in real-time by automatically verifying a member’s eligibility and authorizing the claim request offering members a smooth patient’s experience without delays.

Empowers payers to monitor and follow-up on every step of the claim’s process: claims details, paid and outstanding out-patient services invoices, savings generated on incurred out-patient claims, and many other detailed reports that support critical program monitoring. Hence ensuring transparency, data integrity and a complete out-patient claims trail.

Our PMMA application empowers you with: 

• The flexibility to accommodate your policy benefits and restrictions and smoothly manage your portfolio
• The ability to conveniently manage and apply changes to members data such as additions, deletions, and printing insurance cards.

Our Network management application allows you to customize your network and configure your specific price list & contractual agreement terms with healthcare providers.

In this light, GlobeMed provides healthcare providers with the necessary training on the use of the healthcare provider portal, i*Care, to ensure smooth user experience. Using i*Care, healthcare providers can promptly verify the patient’s eligibility and easily process their pre-authorization requests. The system will automate up to 80% of the claims requests based on our medical rules engine, ARC along with controls related to policy and business rules.

The app allows you to:

• Digitally process your claims, increase automation, and detect any medical discrepancies, waste & misuse.
• Access to approvals issuance, claims process and reimbursement 

Chronic diseases have different posting durations on our online system as a chronic condition requires long-term medical treatment. Thus, to renew treatment or extend chronic post, further updated supporting documents might be needed. Our app will allow you to post the relevant required labs /scans to the member in order to renew the treatment.

Furthermore, your team can follow up with the member to update him/her about the regular chronic review. Consequently, the member can choose between visiting the doctor, or use the teleconsultation service, or request a home visit from the doctor.

Empowers payers to monitor and follow-up on every step of the claim’s process: claims details, paid and outstanding out-patient services invoices, savings generated on incurred out-patient claims, and many other detailed reports that support critical program monitoring. Hence ensuring transparency, data integrity and a complete out-patient claims trail.

GlobeMed Egypt online application “i*Care” is an advanced web-enabled application, handling and issuing approvals based on policy parameters. It allows online eligibility check, certification of coverage, highly automated prior approvals and full claims processing. This will enhance insured members’ experience by reducing their waiting times at healthcare facilities.

Our system enables automated eligibility controls (policy and administrative), computation of financial limitations and co-payments, real time application of policy and exclusions, medical expert rules and tariff agreements with providers.

For grey areas, the system routes the approval request to an approvals agent to take the necessary action. Thus, maintaining real time logging as well as cost containment.

GlobeMed Egypt prides itself for having a combination of advanced applications and professional staff working in tandem to process and audit claims in a timely and efficient manner resulting in minimal processing average turn-around time (30 days) without compromising cost containment requirements.

GlobeMed Egypt receives invoices issued by providers within the network and undertakes the necessary auditing and control procedures to make sure that the bills are in accordance with coverage granted to its employees whilst in accordance to agreed tariffs and based on medical necessity (Usual, Customary and Reasonable).

Furthermore, we generate claims and production reports along with monitoring reports to check the performance of your portfolio.

Available 24/7 with a comprehensive call center services for claims and approvals submittal and to answer queries and complaints. 

To receive and address members’ inquiries, approvals requests, chronic posts and check the providers' network.

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To keep members informed of their claim’s coverage decision along with the OTP service for security.

Insurance module: Managing health insurance anytime, anywhere

• Insured members can manage their claims and those of their dependents including reimbursement & chronic prescription refills, and pre-approval requests
• Use the e-card to access healthcare facilities
• Locate the nearest healthcare provider within the network
• Access policy details, and much more

Health, Fitness & Nutrition modules: Supporting members in their health journey

• Set and manage weight and nutrition targets through daily personalized goals for fitness activity and calorie consumption
• Monitor calorie intake and retrieve food nutritional values while keeping track of your fitness activities
• Maintain your health records by saving your medical tests results and drug prescriptions with the option to enable pill reminders



Click here to download the app

To provide insured members with smooth patient’s experience during their visit to the hospital. GlobeMed Egypt has 16 field offices at major hospitals across Egypt. our field representatives are available to receive insured members during the working hours of outpatient clinics, and to address all inquiries including doctor visit booking. In addition to facilitating the admission approval process, our field agents are ready to coordinate access to services with providers, resolve any on-the-spot issues & complaints and to answer all enquiries related to insurance policy and services.

Click here to check the locations of our field offices.

With doctors where members can consult their doctor of choice from the comfort of their homes. They can choose from a wide range of specialties including gastro-enterology, obstetrics and gynecology, dermatology, cardiology, pediatrics and E.N.T.

To access the service, either click here or download GlobeMed FIT.

The second medical opinion service allows patients to get a review of their diagnosis by a consultant in the relevant field and confirm the first diagnosis to avoid any possible misdiagnosis, and unnecessary procedures.

Click here to access the service.

We offer insured members a convenient medication delivery service for free through our online portal along with the sample collection of lab tests upon the member’s request. 

Download GlobeMed FIT to benefit from this service.