|
|
MEDISCOR
(PTY) LTD |
NOTIFICATION 17OF2009 |
03/12/2009
|
|
Medical Scheme |
GetMed |
|
Administrator |
GetMed |
|
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 GetMed as outlined
below.
Herewith the detail for submitting medicine claims to
Mediscor:
|
1. |
Scheme Code (PCN) |
1. |
MDS0060 |
|
2. |
Switch Destination Code |
2. |
GETM0001 |
|
3. |
EDI Activation Code
(Dispensing Doctors) |
3. |
No |
|
4. |
MRP® |
4. |
Yes |
|
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. |
11 Numerical digits |
|
16. |
Payments to Providers |
16. |
GetMed |
|
17. |
Chronic pre-authorisation Mediscor ChroniLine™ |
17. |
GetMed |
|
18. |
Reimbursement structure –
Pharmacies |
18. |
SEP + 26% / R26.00 |
|
19. |
Scheduled 0 or
Unscheduled |
19. |
SEP + max mark-up of 31%
(VAT Excl.) |
·
MEDISCOR REFERENCE PRICE (MRP®) – information available on
www.mediscor.net
·
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 GetMed effective from 1 January 2010:
Options:
Gold Range
- G1000
- G500
- G200
Blue Range
- B300
- B200
- B100
- SP500
|
OPTIONS |
BENEFITS APPLICABLE |
LEVY / CO-PAYMENT |
MRP® |
EXCLUSIONS |
|
G1000 G500 G200 B300 B200 B100 SP500 |
Acute |
No Levy |
Yes |
6, 37, 40, 51, 62 |
|
Chronic (excluding B100) |
||||
|
HIV / AIDS(excluding B200 and B100) |
||||
|
OTC |
No Levy G1000 – maximum of R75
per script G500 – maximum of R75 per
script G200 – maximum of R75 per
script B300 – maximum of R40 per
script B200 – maximum of R40 per
script B100 – maximum of R40 per
script SP500- maximum of R40 per
script |
CHRONIC MEDICINE APPLICATIONS:
Members need to apply and register for Chronic Medicine Benefits with GetMed on
0800 002 505.
If you require any assistance, please contact:
|
Mediscor’s Share Call
Centre Helpline |
: |
0860 113 238
or 0860 117 705 |
Kind regards.
JACK PEREL