On-Line Real Time Briefing Session

1. On-Line Real Time Briefing Session • 30 January 2012

2. ROAD ACCIDENT FUND • BRIEFING SESSION – On Line Real Time / EDI Service. • GAUTENG • RAF/2012/00007 • DATE: 30 JANUARY 2012 • RAF - MENLYN

3. AGENDA • Welcome • Introduction of the RAF members • Circulation of Attendance Register • Presentation By RAF - BAU/Medical Bills • Presentation by Procurement • Q & A • Closing

4. RAF Overview • Established through an act of Parliament in 1996. • Started operating in 1997. • National Public entity in accordance with schedule 3A of the PFMA. • Governance: Parliament through SCOPA; Ministry of Transport; Board of RAF • Provide compulsory cover to all users of South African roads, both citizens and foreigners, against injuries sustained or death arising from MVA within the borders of South Africa. • Rehabilitate and compensate persons injured in a timely and caring manner. • Promote safe use of all South African Roads • Social responsibility to re-integrate victims of road accidents to society. • Pays medical and related services costs; general damages; loss of income; loss of support and funeral expenses. • RAF pro-actively reaching out to communities by expanding the footprint, enhancing processing capability buy improving business processes and systems. • Values: Ubuntu; Freedom to succeed and Pride in what we do.

5. ZIMBABWE NORTHERN PROVINCE MOZAMBIQUE BOTSWANA Pietersburg MPUMALANGA Pretoria Mmabatho Johannesburg GAUTENG NORTH WEST NAMIBIA Welkom Upington FREE STATE KWAZULU NATAL Kimberley Bloemfontein Pietermaritzburg LESOTHO Durban NORTHERN CAPE Umtata ATLANTIC OCEAN EASTERN CAPE Grahamstown East London Stellenbosch WESTERN CAPE Cape Town Port Elizabeth INDIAN OCEAN

6. BACKGROUND • Current transformation process. • Envisaged nine provincial offices for origination of claims. • All claims to be processed centrally at the Benefit Administration Unit (envisaged). • Claimed benefits include Medical; General Damages; Funeral; LOE and LOS. • Medical Unit is responsible for payment of past medical expenses; rehabilitation services; life care and supplier claims. • In 2010/2011 financial year 195,634 Medical claims lodged and 187,168 finalised. • 126,486 of the finalised are supplier claims. • 2010/2011 - Medical payments close to 800 million rand. • Estimated/expected to increase by 8-10%. • Rehabilitation and Life Care Services are pre-authorized. • Payments are made to service providers, attorneys and claimants.

7. SYSTEMS AT RAF • Currently two systems run parallel • In-house built Old Claims system/legacy system • Fineos claims processing system introduced in 2009/2010. • Manual/electronic processing of claims • Document storage at SharePoint (back up) • Payment control via SAP for both systems. • Need for thorough duplicate checks before processing

8. OPERATING ENVIRONMENT AT RAF • Windows • IBM AIX • HP UNIX • DATABASES : Oracle and MSSQL

9. CLAIMS PROCESS ON FINEOS • Lodgement • Scanning • Indexing/intake/Verification • Merits Assessment • Benefit Assessment • Payment request/approval • Payment control with SAP • Settlement and/or Undertaking Certificate • Rehabilitation and/or Life Care

10. EDI SPECIFICATIONS • On-Line Real Time Healthcare technology to facilitate processing and payment of medical claims. • On Line Real Time link between service provider systems and RAF • Direct Link with HPCSA and BHF • Medical Intelligence • Pricing (tariffs) and service validation technology. • Built-in billing rules. • Payment response messaging • Automatic updates • System driven quantity and quality checks for pre-authorised treatment. • Centralised patient records for RAF. • The system should have robust audit trails. • On site and remote technical support. • Seamless integration regardless of service provider system or RAF. • Enable direct submission for pre-authorized services • Give solutions to the supplier’s claim challenge • Configuration to all communication methods ( e.g. 3G, ADSL, etc). • Adequate Storage Capacity • Training of super users / train the trainer • Training manual

11. Technical Mandatory Requirement • The service provider must have full local solution support. • Please provide the structure of the support team to the RAF

12. Technical / Functional Requirements • Technical /functionality will be evaluated against the following detailed requirements: • Project plan and methodology • Experience • Standard Operating Procedures • Security Features • Training plan • Report Generation • Site visit

13. Details of the Bid • Request for proposals: Appointment of a service provider to provide • On-Line Real Time Healthcare Claims processing technology system • Closing date 9 February 2012. • All questions / enquiries outside this forum will be via email to: tsholok@raf.co.za not later than 11:00 on 2nd February 2012. • Questions/ Answers will be published on the RAF website by 3rd February 2012.

14. Details of the Bid • Documents can be couriered or hand delivered at the reception during: • Mondays - Fridays • Working hours • 7h45 a.m. – 16h00 p.m. • Please ensure that register is signed at the reception • Closing date and time should be strictly adhered to: • 9 February 2012 at 11h00 a.m. sharp

15. Compliance • Compulsory Documents (Valid original Tax Clearance Certificate) • Page 5-Checklist of documents to be submitted • Please ensure that document is signed where required • Complete proposal should be submitted

16. Evaluation • Functionality • Bidders who score less than 60% out of 85% on functionality will not be considered for site visit • Bidders who score less than 80% out of 100% will be not be considered for further evaluation on price and BEE

17. Evaluation • 90/10 principle will be used. • Price and BEE

18. QUESTIONS

19. THANK YOU