Custom, built in days

Claims agent for HCF

The claims agent for HCF explains HCF statements line by line and chases missing claim documents.

Ridgeway LogisticsClaims agentWhatsApp
  1. Customer: Why do I still owe R640 on this?
  2. Read statement dated 3 OctoberHCF
  3. Claims agent: Your scheme paid R1,560 of the R2,200 specialist bill, at the scheme’s rate. The R640 left is the specialist charging above that rate. You could ask the rooms if they’ll accept the scheme rate.
  4. Customer: Can you ask them?
  5. Claims agent: I can draft the message for you to send, with the claim details. Want it?
Sample conversation. People, brands and figures are made up.

What it can do with HCF

  • Explains HCF statements line by line and chases missing claim documents
  • Read a member’s HCF plan and benefits through the access your team has, such as an API, a file feed or a portal export
  • Answer cover questions from your HCF plan documents, with the figures for the member’s plan
  • Check a claim’s status and chase the missing invoice, referral or form with the member

Questions

What does the claims agent do with HCF?

Explains HCF statements line by line and chases missing claim documents.

Is the HCF connector live?

Not yet as a ready-made connector.

Does the claims agent change claim outcomes?

No.

Does the agent decide HCF claims or authorisations?

No.

Can HR see what staff say to the agent?

No.

Ollie’s agents give wellness guidance. They don’t diagnose or prescribe, and hand off to a human expert when needed.