Verirad (Pty) Ltd

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Specialising in the assessment of radiology and pathology accounts on behalf of Medical Schemes

Pathology and Radiology Spend Managers - Health Fund Risk Managers

We specialise in the assessment and verification of Radiology and Pathology accounts on behalf of Medical Schemes and Administrators. In recent years monitoring of both medical claims and medical expenditure on a global basis has indicated an unprecedented growth in the area of diagnosis testing such as pathology and radiology. Presently diagnostic imaging is the third largest and fastest growing expense for medical schemes.
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Diagnostic Radiology imaging includes:

  • MRI (magnetic resonance imaging)
  • CT (computed tomography)
  • PET (positron emission tomography)
  • Interventional radiology
  • Ultrasound
  • Nuclear medicine
  • Digital mammography
  • Molecular imaging
  • General black and white Xrays

Diagnostic Pathology tests includes:

  • Andrology
  • Bacteriology
  • Biochemical tests
  • Cytology
  • Haematology
  • Histology
  • Human Genetics
  • Immunology
  • Microbiology
  • Serology

Radiology and Pathology utilization management has become a top priority for Medical Schemes as verification of these accounts eliminates duplicate submissions and ensures correct billing practice. The main objective of Verirad is to offer Radiology and Pathology Management Service to Medical Schemes in order to reduce their expenditure in this field that comprises roughly 11% of Medical Scheme spend.

red tick Ensure Regulatory and Statutory Compliance
red tick Reduce radiology/pathology expenditure
red tick Behaviour modification regarding practice billing
red tick Data Analysis – trend identification and profiling of providers, members and referring doctors
red tick Forensic Accounting Analysis and Duplicate Recovery on unmanaged claims
red tick Financial and Clinical account auditing
red tick Preferred Provider Consultation
red tick Capitation Arrangement Advice
red tick Risk share Arrangements
red tick ICD10 - NHRPL X-WALK
red tick Possible Hospital Acquired Infection identification
red tick Working with existing HIV, Diabetic and Oncology management programs and identify non-registered beneficiaries
red tick Many other determinants out of our developing database

The data analysis is comprehensive and performed by a statistician with the following criteria included:-

  • Referring Practitioner
  • Referring Practitioner discipline
  • Radiology/Pathology Practice
  • Demographics
  • Radiology/Pathology Active beneficiaries
  • Geographical distribution
  • Expenditure evaluation on specified tariff codes

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