|
|
MEDISCOR
(PTY) LTD |
NOTIFICATION 36OF2009 |
15/12/2009
|
|
Medical Scheme |
Malcor Medical Scheme |
|
Administrator |
Allcare 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 MALCOR Medical Scheme as outlined below.
Herewith the detail for submitting medicine claims to
Mediscor:
|
1. |
Scheme Code (PCN) |
1. |
MDS0003 |
|
2. |
Switch Destination Code |
2. |
NMMD0000 |
|
3. |
EDI Activation Code
(Dispensing Doctors) |
3. |
104P |
|
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. |
7 Numerical |
|
16. |
Payments to Providers |
16. |
Allcare |
|
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. |
Schedule 0 or Unscheduled |
20. |
SEP + max mark-up of 26% (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 MALCOR effective
from 1 January 2010:
|
OPTIONS |
BENEFIT STRUCTURE |
LEVY / |
MMAP© |
EXCLUSIONS |
|
Plan B Plan C |
Acute |
No levy |
Yes |
1-5,11,15, 17, 19, 20, 21-25,27,30-32,
38,40-41,43-45,50, 53, 55, 58,60-62 |
|
Chronic |
No Levy |
|||
|
OTC |
No levy – part of acute |
|||
|
Surgical |
No levy |
|||
|
Psychiatric Benefit |
No levy |
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|
Prescribed Minimum Benefits (PMBs) |
Mediscor Extended Formulary: Malcor A: Formulary products: No Levy Non-formulary products: N/A
Malcor B: Formulary products: No Levy Non-formulary products: Malcor B - Pay from acute Mediscor Basic Formulary: Malcor C: Formulary products: No Levy Non-formulary products: Malcor C - Pay from savings |
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|
Oncology |
No Levy |
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|
Radiology |
No Levy |
Pre-authorised products will allow 1 refill
every 26 days.
PRESCRIBED MINIMUM BENEFITS (PMBs) –
Mediscor Basic, Standard and Extended Formularies:
Members need to apply 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