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Our  Healthcare Claims News South Africa | Smartchoice Technology

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Simplifying Healthcare Admin with Smart Technology

Healthcare administration shouldn’t be a barrier to delivering exceptional care. At Smartchoice Technology, we’re redefining what’s possible for medical schemes, administrators, and providers across South Africa. By drawing on tested global health administration solutions and combining them with our local expertise, we transform complex processes into seamless operations — so you can focus on what really matters: your members.


Why Healthcare Administrators Choose Us

In an era of rising costs and increasing regulatory complexity, our fully integrated platforms provide the clarity and control you need. We understand the unique challenges facing South African medical schemes:

  • Members demanding faster, more transparent service
  • Providers frustrated by slow reimbursements
  • Regulators requiring stricter compliance
  • Boards needing better cost management

Our technology bridges these gaps through intelligent automation, real-time data integration and proven interoperability – all tailored for our local healthcare landscape.


Your Complete Digital Administrator

Smartchoice Technology brings together globally proven health administration capabilities, strengthened with local delivery, compliance, and support. Our integrated platforms offer:


1. Core Claims Processing Engine

  • Processes medical, dental and vision claims with 99.9% accuracy
  • Automatically applies tariffs, benefits and rules – no manual checks needed
  • Handles high volumes effortlessly (scales from 100 to 100,000+ claims daily)
  • Compliance-ready with ICD-10, CPT coding and POPIA requirements

2. Smart Add-On Modules (Mix & Match)

  • Provider Network Manager
  • Dispute resolution and payment tracking
  • Automated credentialing and contracting
  • Care Coordination Suite
  • Chronic disease program management
  • Preventive care and wellness tracking

3. Future-Proof Integration

  • Connects seamlessly to your existing systems
  • Supports EDI, HL7 and API integrations
  • Cloud or on-premises deployment

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Proven Results for South African Schemes

Our clients typically see measurable improvements within 3-6 months:

Performance improvements achieved by Smartchoice Technology solutions
Metric Average Improvement
Claims processing time 40-60% faster
Administrative errors 30-50% reduction
Provider payment cycles 25-35% quicker
Member satisfaction scores 20+ point increase

Case Spotlight: Proven Global Impact

Our partners solutions have powered some of the most complex healthcare administration environments in the United States — from state Medicaid programmes to large Medicare Advantage plans.


Why This Matters for South Africa

Through Smartchoice Technology, these tested global solutions are being localised for the South African market. With our Johannesburg-based delivery team, regulatory compliance expertise, and regional partnerships, we ensure that innovations with proven global impact are anchored in local execution capacity.


More Than News – A True Partnership

What really differentiates Smartchoice?

  • Local Implementation Team: Johannesburg-based specialists who understand SA healthcare
  • Transparent Pricing: No hidden fees – pay only for modules you use
  • Continuous Optimisation: We tune the system as your organisation grows and evolves.

Take the First Step Toward Smarter Administration

  1. Quick Assessment: [Download our ROI Calculator] to estimate your potential savings
  2. See It Live: [Book a Platform Demo] tailored to your scheme’s needs
  3. Personalised Consultation: Speak with our healthcare technology specialists at 0800 SMARTZA

Whether you're managing thousands or millions of members, our flexible, cloud-ready infrastructure ensures efficient claims adjudication, real-time data processing, and system-wide interoperability. With automated workflows, configurable business rules, and API-driven integrations, the platform adapts to your organisation’s needs—both today and in the future.
Scale with confidence—choose Smartchoice Technology and the PLEXIS Platform for a future-ready healthcare administration solution.

The Smartchoice-enabled PLEXIS Platform puts control in your hands with intuitive self-service tools designed to enhance efficiency, reduce administrative burden, and improve member and provider engagement. Our platform offers secure, user-friendly portals that allow members to manage their benefits, providers to track claims and payments, and administrators to configure workflows and automate processes—all without IT intervention.

SCT-Plexis Platform stands out as an exceptionally adaptable solution, meticulously engineered to align with your organisation's unique requirements. It's not just News; it's a bespoke solution that molds to the contours of your operational needs, ensuring that every aspect of your service delivery is optimised for excellence.

The SCT-Plexis platform redefines flexibility in benefit plan management, offering unmatched configurability. It streamlines the administration of members/groups, custom benefit classes, fee schedules, gap, and co-payments with ease. Empower your organisation with Plexis—where managing healthcare benefits is simplified, precise, and efficient.

Empowering Excellence, Elevating Healthcare. Contact Us