Company
About ClaimIQ SA
ClaimIQ SA reviews and disputes rejected medical aid claims on behalf of members across South Africa. When a scheme declines, short-pays or partially settles a claim, we establish whether that decision was correct — and where it was not, we build and lodge the dispute to have it overturned.
What we do
Independent clinical reviewers and dispute specialists reversing medical aid denials across South Africa. Regulated under POPIA and aligned with the Council for Medical Schemes.
Every matter follows the same route: you upload your rejection letter, hospital account and clinical notes; we read and audit them against your scheme’s own rules, the ICD-10 Master Industry Table and the Prescribed Minimum Benefit regulations; a human reviewer verifies the findings and drafts the dispute; and we lodge it with your scheme, escalating to the Council for Medical Schemes where the scheme fails to resolve it.
Independent clinical reviewer and dispute specialist model
We are not brokers, not an intermediary for any scheme, and not paid by any scheme. Our only duty is to the member whose claim we are reviewing, which is why we charge a single flat Case Review fee based on the size of the claim rather than a percentage of what is recovered.
No commission, no success fee and no cut of your recovery — every rand your scheme pays back goes to you. Our work is administrative, clinical and dispute-resolution based. We do not sell medical aid or gap-cover products, we do not provide financial advice as contemplated in the Financial Advisory and Intermediary Services Act 37 of 2002 (“FAIS”), and we are therefore not licensed as a Financial Services Provider.
AI-assisted, human-verified
In the interests of transparency, we disclose that part of our review is performed by an automated AI clinical audit pipeline. The pipeline reads the documents you upload, extracts diagnosis and procedure codes, checks them against the ICD-10 Master Industry Table and Prescribed Minimum Benefits (PMB) rules, and produces a draft audit result and suggested resubmission letter.
The AI output is a decision-support tool. It is reviewed by a human on our clinical / dispute team before any dispute is submitted to your medical scheme on your behalf. You have the right to request human intervention, to express your view, and to contest a decision made about you as contemplated in section 71 of POPIA. Full detail is set out in our POPIA Notice.
Your information and your rights
We process health information, which POPIA treats as special personal information, only with your explicit written consent and only for the purpose of pursuing your claim. Your rights of access, correction, objection and complaint, together with how long we retain your file, are set out in our POPIA Notice and Complaints Procedure.
Contact us
ClaimIQ SA (Pty) Ltd
Registration No.: [Pending CIPC Registration]
Email: support@claimiq.co.za · privacy@claimiq.co.za