|
|
MEDISCOR (PTY) LTD |
NOTIFICATION
38
OF
2008 |
12 December 2008
|
|
Medical Scheme |
Prosperity Health Namibia – All Schemes 1.
NAMDEB 2.
RENAISSANCE Namibia 3.
NAPOTEL 4.
Road Contractors Company 5.
Prosperity Life |
|
Administrator |
Prosperity
Health Namibia |
|
Information Relevant to |
Benefits
and Options for 2009 – All Namibian Pharmacies |
|
Effective Date |
1
January 2009 |
With effect 1 January 2009,
Mediscor will be applying the scheme rules for the following PROSPERITY HEALTH
NAMIBIA SCHEMES as outlined below.
To facilitate the electronic
submission Mediscor has only contracted MediSwitch Namibia. Therefore all
claims must be sent to Mediscor via MediSwitch Namibia and NO transaction fees
will be charged to pharmacies.
Herewith the details for
submitting medicine claims to Mediscor:
|
1. |
Scheme Code – Prosperity Namibia All Schemes |
1. |
NAM0100 |
|
2. |
MediSwitch Namibia Destination Code |
2. |
RHMS0001
|
|
3. |
NAMIBIAN Mediscor Reference Price (NMRP) |
3. |
YES |
|
4. |
EDI Activation Code (Dispensing Doctors) |
4. |
No |
|
5. |
Maximum supply of medicine |
5. |
30 Days |
|
6. |
Days of supply of the dispensed medication |
6. |
Yes /Compulsory |
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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 |
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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. |
NO |
|
15. |
Membership number requirements |
15. |
7 Numerical
|
|
16. |
Payments
to Providers |
16. |
Prosperity
Health Namibia |
|
17. |
Chronic pre-authorisation |
17. |
Mediscor – ChroniLine |
|
18. |
Reimbursement structure – Pharmacies |
18. |
SEP + 50% + N$2.50 + broken bulk + container fee + 15% TAX |
|
Individual
Scheme codes |
MediSwitch Namibia (Destination code) |
Mediscor Scheme Code |
|
Prosperity Health Namibia All Schemes |
RHMS0001 |
NAM0100 |
|
1. NAMDEB Medical
Scheme |
NAM0101 |
|
|
2. NAPOTEL Medical Aid
Fund |
NAM0102 |
|
|
3. Road Contractors Company (RCC) Medical Aid Fund |
NAM0103 |
|
|
4. Renaissance Health Medical Aid Fund (Prosperity) |
NAM0104 |
|
|
5. Prosperity Life Medical Aid Fund |
NAM0105 |
Herewith the Scheme rules for PROSPERITY HEALTH NAMIBIA effective
from 1 January 2009:
|
SCHEME |
Mediscor Scheme Code (PCN) |
MediSwitch Destination Code |
LEVY |
EXCLUSIONS |
NMRP |
|
Prosperity Health Namibia - All Schemes |
NAM0100 |
RHMS0001 |
As per online response |
As per online response |
Yes |
|
NAMDEB |
NAM0101 |
N$5,00 per Item |
4-6, 15, 19, 21-25,
27,28, 31-32, 38, 40-41, 43-45, 50-51, 61-62 |
||
|
NAPOTEL |
NAM0102 |
20% (min N$25,00 max N$50,00 per Rx) |
3-9, 11, 15, 17, 19,
22-25, 27, 31-32, 44, 61-62 |
||
|
Road Contractors Company |
NAM0103 |
15% |
1-11, 15, 17, 19, 22-25, 27, 31-35, 44-45, 58, 61-62 |
||
|
Renaissance (Prosperity) |
NAM0104 |
15% (min N$25.00 per Rx) |
2, 4-6, 15, 21-27, 31-32, 35, 44-45, 58, 60-62 |
||
|
Prosperity Life |
NAM0105 |
As per online response |
1-6, 15, 19, 20-27, 31-35, 42, 44-45, 57-58, 60-62 |
IF YOU REQUIRE ANY ASSISTANCE, PLEASE
CONTACT:
Claim & Client Services
: 061 299 9000
MediSwitch Namibia : 0800 112 233
Pre-authorisation / Chronic : 061 299
9990
Mediscor PBM (South Africa) : +27 12 674 8000
Kind
regards
JACK
PEREL