Healthcare technology. Local delivery.info@smartchoice.org.za+27 83 288 3776
Products and solutions

Cloud-Native Scheme Administration.

Deploy standalone modules where you need them most—or unify your entire administrative ecosystem under one cloud engine. Smartchoice gives South African medical schemes and administrators straight-through claims adjudication, dynamic provider management, real-time member engagement, and auditable claims risk controls.

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01 / Solution

Unified Scheme Operations

Connect membership, scheme benefits, provider registries, and claims adjudication around your exact operational rules.

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02 / Solution

Intelligent Claims Adjudication

Accelerate straight-through processing with automated tariff pricing, clinical rule validation, and transparent exception routing powered by Smartchoice Claims.

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03 / Solution

Provider & Network Governance

Centralise practitioner records, practice hierarchies, facilities, and DSP contracting tiers in a single cloud source of truth.

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04 / Solution

Enquiry Governance & Support Operations

Bring structure, transparency, and POPIA-compliant auditability to member and provider interactions—linking real-time eligibility and claim histories directly to SLA-monitored resolution paths.

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05 / Solution

Claims & Data Exchange

Intercept billing errors at the point of submission. Smartchoice Exchange cross-references live scheme rules and provider networks to surface discrepancies instantly—enabling collaborative, upstream corrections before claims reach the adjudication queue.

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06 / Solution

Fraud, Waste & Abuse (FWA) Mitigation

Move beyond costly post-payment clawbacks. Enforce deterministic duplicate screening, anomalous billing triggers, and multi-tier clinical review queues—stopping improper claims upstream while maintaining fair, defensible provider relationships.

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