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|
MEDISCOR
(PTY) LTD |
NOTIFICATION 13OF2010 |
Date: 20 July 2010
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|
Medical Scheme |
Medihelp Medical Scheme |
|
Administrator |
Medihelp Medical
Scheme |
|
Information Relevant to |
New Option: Necesse |
|
Effective Date |
1 August 2010 |
Effective 1 August 2010, Mediscor will be processing claims for the
following Medihelp option, in conjunction with Prime Cure.
·
Necesse
(MDS0010)
Herewith the detail for submitting medicine claims to
Mediscor:
|
1. |
Scheme Code (PCN) |
MDS0010 |
|
2. |
Switch Destination Code |
MGFM0001 |
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3. |
EDI Activation Code (Dispensing Doctors) |
256P |
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4. |
MMAP© |
Yes |
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5. |
Maximum supply of medicine |
30 Days |
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6. |
Days of supply of the dispensed medication |
Yes /Compulsory |
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7. |
Membership number as per membership card |
Yes / Compulsory |
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8. |
Dependant code as per membership card |
Yes / Compulsory |
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9. |
Dependant first name as per the membership card |
Yes / Compulsory |
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10. |
Dependant date of birth |
Yes /Compulsory |
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11. |
Dependant’s gender (male/female) |
Yes / Compulsory |
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12. |
Practice number of the prescriber |
Yes / Compulsory |
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13. |
ICD-10 Diagnostic code |
Yes / Compulsory |
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14. |
9 digit NAPPI code of medicine dispensed |
Yes / Compulsory |
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15. |
Membership number requirements |
7 Numerical |
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16. |
Payments to Providers |
Medihelp |
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17. |
Chronic/PMB pre-authorisation |
Medihelp / Medichron |
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18. |
Reimbursement structure |
Medihelp Reimbursement Rate |
·
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.
|
OPTIONS |
BENEFITS APPLICABLE |
LEVY / CO-PAYMENT |
MMAP© |
|
|
Medihelp Necesse |
Oncology |
No levy |
Yes |
Requires pre-authorisation Medichron |
|
Specialist |
No Levy |
Yes |
Restricted to Prime
Cure formulary |
PRE-AUTHORISATIONS:
Members need to apply for Oncology and Specialist
referral authorisations with Medichron/Medihelp 0860 100 678.
If you require any assistance, please contact:
|
Mediscor’s Share Call
Centre Helpline |
: |
0860 113 238
or 0860 117 705 |
Kind regards.
JACK PEREL