Medical Management, Administrative Services, Providers Network Management



PMCare processed over 2.76 million medical claims worth of RM591 million in year 2010. From this amount, the value of claims transacted via our Mediline™ in year 2010 was more than RM181.2 million. It has increased more than double than the value processed five years ago in year 2006 at RM71 million only. The average number of GP clinics that have submitted their medical claims to us have also increased from1,521 in year 2006 to 2,074 in year 2010. This is an endorsement and proof that our Mediline™ is well accepted by the GP clinics as the mode of submitting their medical claims to PMCare. With increase number in our Members, we expect more medical claims will be transacted through the Mediline™ for this year. Until May this year, we have processed more than 1 million medical claims amounting to RM84.2 million from 2,134 GP clinics. It is estimated that the value of medical claims to be transacted via Mediline™ for the whole year of 2011 in the region of 2.47 million medical claims worth of more than RM202 million.

Mediline™ is a web-based application system designed and created by PMCare to facilitate and assist our panel GP clinics to verify and validate members, submit medical claims on-line, generate medical summary report which are also being used as invoices by the GP clinics, and to reconcile the invoices against the detailed listing of payment advice for the payments made to the GP clinics. Almost 70% of Mediline™ users are GP clinics located in Selangor, Kuala Lumpur, Perak, Penang and Johor. 


Table 1- Numbers of Providers Submitting via Mediline

Table 2 - Numbers of Claims Submitted via Mediline™.

Table 3 - Total Claims Amount Submitted via Mediline™.