|
|
MEDISCOR
(PTY) LTD |
NOTIFICATION 29OF2011 |
13
December 2011
|
|
Medical Scheme |
The
Building and Construction Industry Medical Aid Fund (BCIMAF) |
|
Administrator |
Universal Healthcare |
|
Information Relevant to |
Benefits and Options
for 2012 |
|
Effective Date |
1 January 2012 |
With effect 1 January 2012, 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. |
Reference Pricing |
4. |
No |
|
5. |
Maximum supply of
medicine |
5. |
30 Days |
|
6. |
Days
supply of the dispensed medicine |
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 diagnosis 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. |
Universal Healthcare |
|
17. |
Chronic pre-authorisation |
17. |
Mediscor ChroniLine™ |
|
18. |
Reimbursement structure –
Dispensing Doctors |
18. |
SEP + 30%/R23.40 |
|
19. |
Reimbursement structure –
Pharmacies |
19. |
SEP + 26%/R26 |
|
20. |
Over the counter (OTC) |
20. |
SEP + 26%/R26 |
·
SEP
(VAT Incl.) and dispensing fee (VAT Excl.)
·
Reimbursement
structure will be applied on scheduled medicines (0 – 8) and unscheduled products.
·
Mediscor Reference Price (MRP®) – 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 2012:
|
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, 40-41, 43-45, 47-51, 53, 55, 58, 61-62 |
|
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 Call Centre |
: |
0860 113 238
or 0860 117 705 |
|
Mediscor ChroniLine™ Mediscor E-Mail |
: : |
0860 119 553 |
Kind regards.
JACK PEREL