Claim switching fees explained: what your practice really pays per claim
A small fee on every claim looks harmless. Over a year, across every visit, resubmission and reversal, it can become one of the bigger lines in your practice costs.
The short version
- A claims switch carries your electronic claims to medical schemes and brings their responses back.
- Practices often pay for this per claim or per transaction, either to the switch directly or through their practice software.
- Resubmissions, reversals and eligibility checks can count as separate transactions.
- To find your real cost, count transactions, not just visits, over a full month.
- On Cliniweb, claim submissions are zero-rated: R0 per claim.
What is a claims switch?
When your practice software sends a claim electronically, it doesn’t go straight into the medical scheme’s system. It passes through a switch: an intermediary that connects many practices to many schemes and administrators. The switch checks the claim’s format, routes it to the right scheme, and returns the scheme’s response to your software.
Electronic switching is a big improvement on paper claims. Claims arrive faster, many schemes respond within minutes, and errors come back while the visit is still fresh. The question isn’t whether to claim electronically. It’s what you pay to do it. (New to the process? Start with how medical-aid claims work in South Africa.)
How practices are charged
Pricing differs between providers, and it isn’t always shown as a separate line. Common models include:
- A fee per claim submitted to a scheme.
- A fee per transaction, where a transaction can be a claim, a resubmission, a reversal or an enquiry.
- Fees for eligibility or benefit checks run before the visit.
- A monthly fee or minimum, sometimes on top of per-transaction charges.
- Switching included in the software subscription, where the cost is built into a higher monthly price or a per-claim charge from the software company.
None of these models is wrong. The problem is that they make it hard to see what each claim really costs, and harder still to compare one system with another.
The extras that add up
When practices work out their claim costs, they usually multiply visits by the per-claim fee. That undercounts. Look for:
- Resubmissions. A rejected claim that you fix and send again may be charged a second time.
- Reversals. Cancelling a claim to correct it can be a transaction in its own right, followed by the new claim.
- Eligibility checks on every patient, including those who end up paying cash.
- Several claims per visit. Separate invoices for the consultation and for medicine, or for two providers, may each be a claim.
Work out your own number
You need two figures from a recent month: how many chargeable transactions you sent, and what you paid for each. Your software or switching statement should show both. If it doesn’t, ask your provider for a per-transaction breakdown.
Example only: not anyone’s actual prices
A practice sees 500 medical-aid patients a month. About 10% of claims are resubmitted after a rejection, adding 50 transactions. At an example fee of R5 per transaction:
- 550 transactions × R5 = R2,750 a month
- R2,750 × 12 = R33,000 a year
Put in your own numbers with our claim fee calculator.
Questions to ask when choosing practice software
- Is there a fee per claim, or per transaction? Which transactions count?
- Are resubmissions, reversals and eligibility checks charged separately?
- Is there a monthly minimum?
- Do scheme responses, rejection reasons and remittances come back into the software, and for which schemes?
- Can the price change, and how much notice do you get?
Claims on Cliniweb: R0 per claim
On Cliniweb, electronic claim submissions are zero-rated. There is no fee per claim and no batch limit. You pay a daily access fee and data storage, about R250 a month for most practices, plus any messages you send. You can see real invoices from Cliniweb practices on our pricing page.
Claims go from the invoice to the scheme or administrator, and you can follow each one to the scheme’s response, with rejection reasons on the invoice and remittances matched to invoices.*
* Remittances and claim status are available on some schemes only. Fees can change with 30 days’ written notice, as set out in our terms.
Frequently asked questions
What is a claim switching fee?
It is what a practice pays to send electronic medical-aid claims through a claims switch, usually charged per claim or per transaction, either directly or through the practice software.
Are resubmitted claims charged again?
It depends on the provider. Under per-transaction pricing, a resubmission or reversal can be charged as a separate transaction. Check your statement or ask your provider.
How do I find out what I pay per claim?
Take one full month’s statement, count the chargeable transactions (claims, resubmissions, reversals and checks), and divide what you paid by that number.
Does Cliniweb charge per claim?
No. Electronic claim submissions on Cliniweb are zero-rated. You pay a daily access fee and data storage, plus any messages you send.