|
|
MEDISCOR
(PTY) LTD |
NOTIFICATION 13OF2009 |
03/12/2009
|
|
Medical Scheme |
The
Building and Construction Industry Medical Aid Fund (BCIMAF) |
|
Administrator |
Status Medical Aid
Administrators |
|
Information Relevant to |
Benefits and Options
for 2010 |
|
Effective Date |
1 January 2010 |
With effect 1 January 2010, Mediscor will be
applying the scheme rules for BCIMAF as outlined below.
Herewith the detail for submitting medicine claims to
Mediscor:
|
1. |
Scheme Code (PCN) |
1. |
MDS0030 |
|
2. |
Switch Destination Code |
2. |
BCIM0001 |
|
3. |
EDI Activation Code
(Dispensing Doctors) |
3. |
733P |
|
4. |
MMAP© / MRP® |
4. |
No |
|
5. |
Maximum supply of
medicine |
5. |
30 Days |
|
6. |
Days of supply of the
dispensed medication |
6. |
Yes /Compulsory |
|
7. |
Membership number as per
membership card |
7. |
Yes / Compulsory |
|
8. |
Dependant code as per
membership card |
8. |
Yes / Compulsory |
|
9. |
Dependant first name as
per the membership card |
9. |
Yes / Compulsory |
|
10. |
Dependant date of birth |
10. |
Yes /Compulsory |
|
11. |
Dependant’s gender
(male/female) |
11. |
Yes / Compulsory |
|
12. |
Practice number of the
prescriber |
12. |
Yes / Compulsory |
|
13. |
ICD-10 diagnostic code |
13. |
Yes / Compulsory |
|
14. |
9 digit NAPPI code of
medicine dispensed |
14. |
Yes / Compulsory |
|
15. |
Membership number
requirements |
15. |
7 Numerical digits |
|
16. |
Payments to Providers |
16. |
Status |
|
17. |
Chronic pre-authorisation Mediscor ChroniLine™ |
17. |
Yes |
|
18. |
Reimbursement structure –
Dispensing Doctors |
18. |
SEP + R20/30% |
|
19. |
Reimbursement structure –
Pharmacies |
19. |
SEP + R26/26% |
|
20. |
Scheduled 0 or
Unscheduled |
20. |
SEP + max mark-up of 31%
(VAT Excl.) |
- MEDISCOR FORMULARIES – information available
on www.mediscor.net
- ICD-10 CODES – information available on
www.medicalschemes.com
IMPORTANT: The details below serve as a GUIDELINE ONLY. Due to the complexities of various Levy,
Co-payment, Formulary and Exclusion criteria; SERVICE PROVIDERS MUST
refer to our on-line responses to apply the correct rules.
Herewith the scheme rules for BCIMAF effective from
1 January 2010:
|
OPTIONS |
BENEFITS APPLICABLE |
LEVY / CO-PAYMENT |
MMAP© |
EXCLUSIONS |
|
BCIMAF |
Acute |
20% Levy |
No |
1-5, 7-9, 11,15, 17, 19-25, 27, 30-32, 36-37,
40-41, 43-45, 47-51, 55, 58, 60-62 |
|
Chronic |
No Levy |
|||
|
OTC |
No Levy – R100 max per prescription |
|||
|
Oncology |
No Levy |
|||
|
Homeopathic (pay from acute) |
20% Levy |
ADDITIONAL CUSTOMISED EXCLUSIONS:
1.
Treatment of
Heamophilia
2.
Treatment of
Cystic Fibrosis
3.
Elastoplast™ /
Band Aid adhesive bandages
4.
Cotton wool
If you require any assistance, please contact:
|
Mediscor’s Toll-free Call
Centre Helpline |
: |
0860 113 238
or 0860 117 705 |
|
Mediscor ChroniLine™ |
: |
0860 119 553 |
Kind regards.
JACK PEREL