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|
MEDISCOR
(PTY) LTD |
NOTIFICATION 35OF2009 |
14/12/2009
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|
Medical Scheme |
Momentum Africa Medical Schemes |
|
Administrator |
Momentum Africa |
|
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 Momentum Africa Medical Schemes as outlined
below.
Herewith the detail for submitting medicine claims to
Mediscor:
|
1. |
Scheme Code
(PCN) |
1. |
MDS0063 |
|
2. |
Switch
Destination Code |
2. |
MHAF0001
|
|
3. |
EDI Activation
Code (Dispensing Doctors) |
3. |
N/A
|
|
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. |
9 digit NAPPI
code of medicine dispensed |
13. |
Yes / Compulsory |
|
14. |
ICD-10
Diagnostic code |
14. |
Yes / Compulsory |
|
15. |
Membership
number requirements |
15. |
Minimum 4
Numerical including dependant code |
|
16. |
Payments to
Providers |
16. |
Momentum Africa |
|
17. |
Chronic
pre-authorisation |
17. |
Momentum Africa |
|
18. |
Reimbursement
structure – Pharmacies |
18. |
S1 to S8: SEP
+ 26%/R26 |
|
19. |
Reimbursement structure –
Schedule 0 and unscheduled medicine |
19. |
SEP +
31% (excl. VAT) |
- 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 Momentum Africa
Medical Scheme effective from 1 January 2010:
Schemes & options:
- Momentum Botswana: Botsogo Health Plan
- Momentum Ghana: Mutual Alliance
- Momentum Lesotho: Bophelo
Medical Scheme
- Momentum Mauritius: Bonne Sante
Health Plan
- Momentum Mocambique: P’La Saude Health Plan
- Momentum Tanzania: Imara
Health Plan
- Momentum Zambia: Wanthanzi
Health Plan
|
OPTIONS |
BENEFITS APPLICABLE |
LEVY / CO-PAYMENT |
MMAP© |
EXCLUSIONS |
|
Momentum Africa |
Acute |
No Levy |
No |
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Chronic |
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HIV/Aids |
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Appliance |
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Organ Transplant |
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Oncology |
If you require any assistance, please contact:
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Mediscor’s Share Call Centre Helpline |
: |
0860 113 238
or 0860 117 705 |
Kind regards.
JACK PEREL