A holistic approach for the management of healthcare benefits
GlobeMed Saudi is the leading and most trusted Third-Party Administrator (TPA) in Saudi Arabia. Following industry best practices and using advanced technology solutions, our specialized professionals will help you to effectively manage healthcare benefits portfolio and to achieve:
- Better cost containment through preferential tariffs and enhanced claims management.
- Operational efficiency by digitizing, automating and optimizing workflows and business processes.
- Superior member experience with self-service tools, field offices and delegates at healthcare providers, for quicker service and safer outcomes.
Superior Customer Journey with Best-in-Class Cost Containment Measures
Our Pharmacy Benefits Management (PBM) solution is designed with the payers and their insured members in mind. While it simplifies the insured members’ journey, offering them a seamless experience, a 24/7 support line and an improved quality and efficiency of treatment, it also contains pharmacy expenditures and enhances financial and clinical performance.
The entire process is digitized from electronic prescribing to secure electronic dispensing at healthcare providers, in addition to various features and programs built to proficiently manage drug utilization for both acute and chronic medications.
GlobeMed Saudi offers its PBM solution - the only home-grown PBM solution in the Saudi market - as a standalone platform 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 to at 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
With flexibility to accommodate your policy benefits and restrictions, and smoothly manage your portfolio.
Step Therapy
Ensuring proper treatment protocols are being followed and unnecessary treatments are minimized.
Formulary Management
Resulting in an efficient use of healthcare resources with the ability of creating multiple customized formularies and tiering systems.
Patient education
Promoting safe medication use by communicating updates on drug safety, medicine recalls, etc.
High Cost Drugs
Managed through clinically-based prior authorization programs helping doctors to determine medical necessity.
Chronic Medication Management
Based on a pre-approval of chronic therapies and an electronic monthly posting of prescriptions to facilitate patients’ journey.
Adherence Management
Through proactive and targeted communications with chronic patients, increasing the chances of treatment success.
Medication Delivery
Thus cutting wait time at the pharmacy.
International Network
With a proven track record of service excellence, GlobeMed provides world-class international health services to your members around the globe, whenever and wherever they need it.
We provide cashless access to more than 120,000 healthcare providers around the world and secure preferential tariffs through our global partners' network.
Automated Cross-Border
GlobeMed’s Automated Cross-Border service, one of the first in the world, allows any 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 for outpatient services generating instant coverage decisions based on the members’ policy details.
Medical Assistance
- Medical Consultation, Evaluation & Referral
- Delivery of Medicine
- Emergency Medical Evacuation
- Emergency Medical Repatriation
- Repatriation of Mortal Remains
- Compassionate Visit
- Care of Minor Children
- Etc.
Premium Platform and Unparalleled Services
The GlobeMed Saudi “Access to Platform” product offers payers the opportunity to adopt their in-house TPA model whereby the services will remain managed by the payer’s human capital while benefiting from the different GlobeMed modules and automated features, which are:
- Fully integrated with the NPHIES platform.
- Already deployed in the Saudi market.
- Successfully performing and guaranteeing enhance patient experience and optimized operation efficiency while automating over 80% of out-patient claims.
- Customized to meet the market’s specific peculiarities.
Payers Applications Suite
Policy Management and Members Administration
With flexibility to accommodate your policy benefits and restrictions, and smoothly manage your portfolio.
Healthcare Providers Network Management
To customize your network and configure your specific price list and contractual agreement terms.
Claims
Management
Driven by our medical rules engine ARC to digitally and accurately adjudicate claims and detect any medical discrepancies and waste.
Reporting and
Analytical Tools
To monitor your claims activities and portfolio performance.
Patients’ Mobile App
GlobeMed FIT
Self-service tool to fully manage their health insurance and wellness.
Add-on Services
We can proudly confirm that payers can leverage on our experience and expertise to handle insured members on their behalf.
- Network management: Benefit from easy access and preferred tariffs with providers in your country and in the region.
- Claims management: We offer you comprehensive claims management services to support your business growth.
The GlobeMed Medical Coding Training program is designed as a solution to close the communication gap between the different stakeholders of the healthcare sector where a common language was highly needed to standardize health information.
In 2002, the training program was initially launched in Lebanon in collaboration with the Saint-Joseph University, one of the most respectable educational institutions in the Middle-East, and was later expended to Qatar, in 2014, where the Ministry of Public Health appointed GlobeMed as the exclusive training vendor for the ICD-10-AM.
It is offered by competent certified medical coders, allowing students to master medical coding skills while accommodating different variations of nomenclatures and international coding standards. The training program provides a balance between theory and practice and is supported by GlobeMed’s e-learning platform.
Special VIP Programs
Experience a care like no other! This is the motto behind GlobeMed Saudi’s VIP services, especially developed to meet the needs and comfort of the VIP members in mind, and designed to assist them every step of their health insurance journey.
The Aurum Program
Aurum offers special service for an ultimate health insurance experience!
A special welcome pack, a distinguished black and gold insurance card, a video of all GlobeMed Saudi services, a detailed user guide, as well as the network of providers’ binder and a set of useful forms:
- A toll-free reservation desk facilitating appointment bookings at network providers
- 24/7 prestigious care agents contacting the member as soon as he/she reaches the provider and offers support every step of the way
- Home delivery services for prescribed medication
- Home laboratory testing services with sampling made at home and delivery of test results.
- Handling of reimbursement claims at your house or workplace.
- Escort services accompanying the member to the healthcare facility and facilitating the process without any waiting time.
- Waving of pre-authorization and limitation.
- Covering the uncovered services to facilitate care.
The Prestigious Care
The prestigious care service is a special out-bound call service dedicated to VIP, Class A and Class B insured members with our clients. Whenever members visit a healthcare provider within the network and as soon as they present the national ID or Iqama, they will be contacted by the GlobeMed Saudi Prestigious care agents, to assist them every step of the way throughout their journey at the healthcare facility, ensuring a hassle-free experience and providing any additional support they may need.
