Your Preferred Healthcare Provider
Fullerton Health covers the whole journey of care – managed care and network management services, primary care, and, diagnostics, specialty and ancillary care.
Vertically integrated healthcare services model and scale of operations across existing markets mean we offer cost-effective solutions to you.
THIRD PARTY ADMINISTRATION
As a leading third-party administrator (TPA), we’ve built a reputation for reliability and excellence. We’ve partnered with a diverse range of clients, including top-tier insurance companies, national, and multinational organizations. Our extensive experience spans a broad spectrum of insured, individual, and group TPA clients.
We specialize in managing complex healthcare services, from intricate in-patient care to outpatient treatments. Our expertise extends to navigating intricate benefit plans, ensuring accurate coverage, addressing exclusions, and effectively handling top-up benefits.
Our core services are customizable to meet your specific needs.
Member Validation
Benefit Eligibility Checking
Limit allowance/ co-payment/ deductibles/exclusions
Automated and escalated guarantees
Individual Case Management
Claim Investigation
Member and Provider Utilisation Review
Fraud and Abuse Detection
Our Commitment
Through our provider network in PNG and preferred networks worldwide we facilitate cashless or reimbursement services
Our services are underpinned by a robust tech platform, optimizing data intelligence and digital adoption to achieve efficiency.
Members have access to our mobile app, and we offer a provider and client web portal, which can be integrated by API/SFTP.
Our backend system is supported by a 24-hour call Centre staffed by doctors & medical professionals. For larger clients we offer dedicated client service teams.
EMERGENCY MEDICAL ASSISTANCE & EVACUATIONS
For over 30 years, we’ve assisted hundreds of thousands of people in times of need and performed thousands of evacuations.
In Papua New Guinea, we facilitate services within our provider network to enable a quality, cashless, and convenient service.
Globally, we partner with 145 reputable assistance providers to deliver services worldwide. We partner with Global Assistance and Healthcare, a Fullerton Health Group company. Our emergency medical assistance, evacuation, and repatriation services provide domestic and global medical assistance, delivered 24/7 by qualified professionals in our Alarm Centre.
We assist in everyday emergencies and pandemics. Whether you’re working from home, in a remote location, or on business travel, we’re there for you.
WHY CHOOSE US?
- E-Card, member benefit, E- Claim, Claim tracking, Providers location, Dedicated phone number, Discharge Button.
- Cashless services in PNG within our provider network
- Second Medical Opinion, obtained locally and or abroad from internationally recognized centers of excellence
- Concierge offering personal assistance, scheduling appointments and lifestyle management.
- Web based and specifically designed to managed various products, complex benefits, integrated in one system: benefit setup, member Enrolment, card printing, call center, claims management, providers portal, client portal & member mobile application.
- Designed as open architecture as part of health care ecosystem and capable of connecting with client system / provider system through API
- Going digital, all claim documents are stored in soft copy supporting faster, easier and efficiency
- Cost containment programs through providers credentialing, rigorous scrutiny of cases, approval and release of Letter of Guarantee, patient monitoring and provider payments
- Real time reporting on our client portal including membership, member benefits, claims pending/paid and standardized reporting options
- Customized reports via API, SFTP or email
- Includes experienced operations professionals, medical staff, client relations, call center executives and claim analysts, available 24/7 client
