Your Claims, Priced at What You Actually Negotiated
Most manual claims processes assess a bill at the amount the facility asked for, because nobody has time to check every contract line by line. Mediloop checks it every time, so the discount you negotiated actually reaches your bottom line instead of evaporating between the contract and the payment. Facilities already on Mediloop are ready to use, and you can bring the rest of your own network onto the platform as well.
Six Things That Happen on the Rail
From the moment a member walks into a facility to the moment that facility gets paid, every step is on one system.
Cover confirmed before care
A facility identifies the member and immediately sees whether they are covered, for what, how much you will pay, how much the member owes, and whether prior approval is required. No phone call to your desk.
Authorisation as a managed process
A request for prior approval arrives with the clinical reason attached, sits on a visible clock, and is decided line by line with a written reason. Requesting and approving are two different people, always. The claim for that same care, once it arrives, is free, since the decision was already made and paid for.
Claims assessed correctly, in order
Your plan is applied as written: waiting period, excess, member share, then the annual ceiling, calculated on the rate you negotiated with that facility. Most manual claims processes assess on the billed amount because nobody checked the contract line by line. This checks it every time.
Patterns one assessor cannot see
A person reading claims one at a time cannot spot a duplicate submitted from two branches, or a facility quietly billing above its peers. Mediloop watches the whole book for exactly those patterns and raises them for a human to judge, since a detection rule is a guess and a wrong guess should never cost a real patient their care.
Facilities paid properly
Approved claims are gathered into a statement per facility with every deduction explained. Money only moves when someone with the authority releases it, and the person who assessed a claim cannot release its payment.
Your business, finally visible
Loss ratios, arrears, facility cost outliers, decision speed, and how much your negotiated rates actually saved you. Every figure states exactly what it is measuring.
A Worked Example
This is the single most valuable thing the platform does, on one claim.
A hospital bills UGX 100,000 for a procedure. Your contract with that hospital agreed UGX 60,000. The member's plan has a UGX 50,000 excess and a 10% share.
Assessed on the billed 100,000. You pay 45,000, the member owes 55,000, and the hospital collects the full 100,000. The discount you negotiated did nothing.
Assessed on the agreed 60,000. You pay 9,000. The member owes 51,000. The hospital collects 60,000, exactly as your contract says.
You saved UGX 36,000 on one claim, against a UGX 1,500 fee to process it. The member's bill went down, not up.
One Overall Price for a Decision
A cover check costs UGX 300. Every other decision, whether it is an authorisation or a claim, costs UGX 1,500 overall. No subscription, no per-member fee, no licence, no minimum. You are invoiced monthly for what was actually processed.
Why the claim after an authorisation is free
The UGX 1,500 fee is for the judgement, not the paperwork around it. When your assessor decides an authorisation, that is where the work happens, so that is what you pay for. The claim that arrives later for that same episode of care needs no second judgement, since the benefit, the member, and the limit were already established. Charging for it again would mean billing one episode of care twice.
The same logic applies to repeat questions. A facility routinely checks a patient at reception, then again at the pharmacy, on the same day. That is one member, one facility, one day, billed once. And every pre-authorised claim and repeat check still shows up on your invoice at zero, so you can see the count matches your own records rather than taking our word for it.
One System for Every Facility You Work With
Facilities already on Mediloop are available to you from day one, and any facility you already work with that is not yet on the platform can be brought on and connected to your book. Either way, cover checks, authorisations, and claims all run through one system instead of a different process for every hospital.
Bring Your Claims Onto the Rail
Talk to our team about your book, your negotiated rates, and how much a lower loss ratio and a quieter month-end are worth to you.