|
|
MEDISCOR
(PTY) LTD |
NOTIFICATION 18OF2009 |
08/12/2009
|
|
Medical Scheme |
Grintek Medical Scheme |
|
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 Grintek Medical Scheme as outlined below.
Herewith the detail for submitting medicine claims to
Mediscor:
|
1. |
Scheme Code (PCN) |
1. |
MDS0065 |
|
2. |
Switch Destination Code |
2. |
STGR0000 |
|
3. |
EDI Activation Code (Dispensing Doctors) |
3. |
259P |
|
4. |
MMAP© |
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. |
12 Alpha-numerical digits |
|
16. |
Payments to Providers |
16. |
Status |
|
17. |
Chronic/PMB pre-authorisation at Mediscor |
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 Grintek Medical
Scheme effective from 1 January 2010:
|
OPTIONS |
BENEFIT STRUCTURE |
LEVY / |
MRP®/ MMAP© |
EXCLUSIONS |
|
Grintek |
Acute Benefit |
No Levy |
Yes |
1-5,11,14-15,19-25,27,
30-32,40-41,43-45, 47-51, 53, 55,61-62 |
|
Chronic Benefit |
No levy |
No |
||
|
Oncology Benefit |
No Levy |
No |
||
|
OTC/PAT |
No levy |
Yes |
||
|
Prescribed Minimum Benefits (PMBs) |
Mediscor Basic Formulary Formulary Products: Unlimited
benefit Non-formulary Products: Pays from Chronic Benefit.
When benefit is exhausted claims will reject. |
No |
MEMBER CLAIMS:
|
1. |
Surgical, orthopedic, stoma and medical appliance. |
|
2. |
Oxygen and delivery systems. |
PRESCRIBED MINIMUM BENEFITS (PMBs): - Mediscor
Basic Formulary
Members need to apply and register for PMBs and Chronic Medicine
Benefits with Mediscor ChroniLine™ on 0860 119 553.
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