|
|
MEDISCOR
(PTY) LTD |
NOTIFICATION 37OF2009 |
15/12/2009
|
|
Medical Scheme |
Prime Cure |
|
Administrator |
Prime Cure |
|
Information Relevant to |
Prime Cure Capitation
Benefits and Options for 2010 |
|
Effective
Date |
1 January 2010 |
With effect 1 January 2010, Mediscor will be applying the scheme
rules for Prime Cure scheme options as outlined below.
·
Only prescriptions written by a Prime Cure
Contracted Physician or Specialist will be accepted.
·
The Prime Cure Formulary will be applied.
Herewith the detail for submitting medicine claims to
Mediscor:
|
1. |
Scheme Code (PCN) |
1. |
As per list below / MDS0300
|
|
2. |
Switch Destination Code |
2. |
PCUR0001 |
|
3. |
EDI Activation Code
(Dispensing Doctors) |
3. |
642P |
|
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. |
Payments to Providers |
15. |
Prime Cure
|
|
16. |
Chronic/PMB
pre-authorisation at Mediscor |
16. |
Yes - Mediscor ChroniLine™ |
|
17. |
Reimbursement structure –
Pharmacies |
17. |
SEP + R26/26%
|
|
18. |
Reimbursement structure –
Dispensing Doctors |
18. |
SEP + R20/30%
|
|
19. |
Reimbursement structure –
Schedule 0 or Unscheduled Medicine |
19. |
SEP + max mark-up of 31%
(Excl. VAT)
|
|
20. |
OTC Claims |
20. |
Yes - Selected Options
|
·
MEDISCOR
REFERENCE PRICE (MRP®) – information available on www.mediscor.net
·
PRIME
CURE CHRONIC/PMB FORMULARY – information available on www.mediscor.net
·
PRIME
CURE ACUTE FORMULARY – information available on www.primecure.co.za or www.mediscor.net
·
ICD-10
CODES – information available on www.medicalschemes.com
MEDICAL SCHEME
OPTIONS CONTRACTED TO PRIME CURE:
|
MEDICAL SCHEME |
PRIME CURE OPTION |
SCHEME CODE |
|
Anglo Medical Scheme |
Value Care |
MDS0301 |
|
BESTmed |
Blueprint |
MDS0302 |
|
Bonitas |
Boncap |
MDS0344 |
|
Eyethumed |
Prime Cure |
MDS0305 |
|
Furnmed |
Prime Cure |
MDS0306 |
|
G4S |
G4S |
MDS0349 |
|
Gen-Health |
Primary
Cover |
MDS0350 |
|
Goldfields Medical Scheme |
Pride |
MDS0341 |
|
Ingwe Health Plan |
Ingwe Capitation |
MDS0308 |
|
Ingwe Health Plan (NEW) |
Medicare (NEW) |
MDS0308 |
|
Ingwe Health Plan |
Pioneer |
MDS0308 |
|
Liberty |
Corporate Network Option |
MDS0345 |
|
Medihelp
(NEW) |
Necesse
(NEW) |
MDS0352 |
|
Minemed |
Affordable |
MDS0342 |
|
Momentum Health |
Access Option |
MDS0322 |
|
Momentum Health |
Base Option |
MDS0322 |
|
Prosano |
Procedure |
MDS0324 |
|
Sizwe |
Affordable
Network Option |
MDS0351 |
|
Suremed |
Explorer |
MDS0347 |
|
SureOne |
Commair |
MDS0336 |
|
SureOne |
Dunn Stores |
MDS0336 |
|
Tlakano |
Basic Option |
MDS0339 |
|
Tlakano |
Comprehensive |
MDS0339 |
|
Tlakano |
LegalWise |
MDS0339 |
|
Tlakano |
MBD |
MDS0339 |
|
Tlakano |
MBP - Med |
MDS0339
|
|
Tlakano |
MDB -
Health |
MDS0339 |
|
Tlakano |
St Davids |
MDS0339 |
|
Tlakano |
Mahala |
MDS0339 |
|
Transmed |
State + Network |
MDS0317 |
|
Umvuzo Health |
Ultra Affordable |
MDS0331 |
|
Umvuzo Health |
Umvuzo Standard |
MDS0331 |
|
World Vision |
World Vision |
MDS0348 |
|
Prime Cure All
Scheme |
Prime Cure All
Scheme |
MDS0300 |
Vendors are
cordially requested to load the Prime Cure Contracted Medical Scheme Options
under the specific Medical Scheme.
E.g. BESTmed options:
-
Blueprint
-
Bonus Plus
-
Millennium Basic
-
Millennium Comprehensive
- Millenium Standard
-
Topcare Current options
-
Vital Care
-
Best Gold
-
Best Platinum
-
Best Goldselect
The Prime Cure Scheme Option is à
-
Blueprint
Should the patient not know on which benefit/plan
option he/she is, then the Prime Cure “All scheme”
claiming code (MDS0300) can be used.
PLEASE
NOTE THAT THE FOLLOWING PRIME CURE SCHEME OPTIONS HAVE BEEN DISCONTINUED FOR 2010.
|
MEDICAL SCHEME |
PRIME CURE OPTION |
SCHEME CODE |
|
Key Health |
Key Cap |
MDS0333 |
|
NIMAS |
Primary Option |
MDS0346 |
|
Thebemed |
Universal Option |
MDS0328 |
|
Topmed |
Network Plan |
MDS0316 |
|
Telemed |
Bronze |
MDS0343 |
|
Laundry Bargaining Council |
Prime Cure Basic |
MDS0309 |
PLEASE NOTE THAT THE FOLLOWING ARE NEW PRIME CURE
SCHEME OPTIONS FOR 2010.
|
MEDICAL SCHEME |
PRIME CURE OPTION |
SCHEME CODE |
|
Medihelp |
Necesse |
MDS0352 |
|
Ingwe Health Plan |
Medicare |
MDS0308 |
If you require any assistance, please contact:
|
Mediscor’s Call Centre
Helpline |
: |
086 011 3238 or 086 011 705 |
Kind regards.
JACK PEREL