Investigation & Verification of Insurance claims

DANIEL VAN COLLER (Principal)
Cell:       083 278 3505
eMail:   daniel@scivs.co.za

WESSIE VAN DER WESTHUIZEN
Cell:      082 578 6525 / 082880 9577
eMail:   wessie@scivs.co.za

What the MRA will do - South Cape Insurance Verification Services

Medical Record Review and Analysis process consists of obtaining, reviewing, interpreting, and understanding the documents in a typical medical record.

The Medical Record Review and Analysis evaluation can be done in the following scenarios i.e.

  • The insurance company provides the medical records and our MRA analyzes the information provided – we submit a Medical Record Review and Analysis Report with our findings based on the provided information – In case like these the possibility exists that not all the medical records were initially collected
  • The insurance company appoints the MRA to obtain the information (field work as below) and analyze the medical records (including insurance provided information) and then a Medical Record Review and Analysis Report is compiled and submitted

The MRA will conduct the following field work:

  • Obtain a letter of consent (that will be required by the hospital to access records)
  • Interview with insured driver (conversation will be recorded)
  • Obtaining the medical records (as above)
  • Interviewing the ambulance staff
  • Interviewing the admission staff
  • Interviewing the attending doctor
  • Determine if any blood samples were taken
  • Obtaining blood analysis reports if blood samples were taken

A medical records analyst typically has administrative duties. These include maintaining information files and processing paperwork. After evaluation, the analyst may also make decisions and find solutions.

Other administrative tasks include monitoring the processes, surroundings, and materials in data handling. The analyst may also review information from events, materials, or the environment to assess problems.

To achieve these goals, creative thinking is often essential. There is a need to develop, design, or create new ideas, applications, systems, or relationships.

Medical records analysts also typically work towards building and developing teams. Within the groups,

there must be respect, mutual trust, and cooperation. It’s only when teams work on such a level that data handling and management becomes efficient.