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MEDISCOR
(PTY) LTD |
NOTIFICATION 39OF 2011 |
21
December 2011
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Medical Scheme |
Prosperity Health
Namibia – All Schemes 1. NAMDEB
Medical Scheme 2. Renaissance
Health Medical Aid Fund (RHMAF) 3. NAPOTEL
Medical Aid Fund 4. RCC
Medical Aid Scheme 5. Prosperity
Life |
|
Administrator |
Prosperity Health
Namibia |
|
Information Relevant to |
Benefits and Options
for 2012 – South African Pharmacies |
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Effective Date |
1 January 2012 |
With effect 1 January 2012, Mediscor will be applying the scheme rules
for the following PROSPERITY HEALTH NAMIBIA SCHEMES as outlined below.
Herewith the detail for submitting medicine claims to
Mediscor:
|
1. |
Scheme Code –
Prosperity Namibia All Schemes |
1. |
NAM0100 |
|
2. |
MediSwitch
Namibia Destination Code |
2. |
RHMS0001 |
|
3. |
Reference Pricing |
3. |
Yes |
|
4. |
EDI
Activation Code (Dispensing Doctors) |
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 |
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9. |
Dependant
first name as per membership card |
9. |
Yes / Compulsory |
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10. |
Dependant
date of birth |
10. |
Yes /Compulsory |
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11. |
Dependant’s
gender (male/female) |
11. |
Yes / Compulsory |
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12. |
Practice
number of the prescriber |
12. |
Yes / Compulsory |
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13. |
9 digit NAPPI
code of medicine dispensed |
13. |
Yes / Compulsory |
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14. |
ICD-10
Diagnosis code |
14. |
No |
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15. |
Membership
number requirements |
15. |
7 Numerical |
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16. |
Payments to Providers |
16. |
Prosperity Health Namibia |
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17. |
Chronic pre-authorisation
|
17. |
Mediscor – ChroniLine™ |
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18. |
Reimbursement structure –
Pharmacies |
18. |
SEP + 28%/R28 |
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19. |
Reimbursement structure –
Dispensing Doctors |
19. |
SEP + 30% /R23.40 |
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20. |
Over the counter (OTC) |
20. |
SEP + 28%/R28 |
·
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
Herewith the Scheme rules
for PROSPERITY HEALTH NAMIBIA effective from
1 January 2012:
|
SCHEME |
Mediscor
Scheme Code (PCN) |
MediSwitch Destination Code |
LEVY |
EXCLUSIONS |
MRP® |
|
Prosperity Health Namibia - All
Schemes |
NAM0100 |
RHMS0001 |
As per online response |
As per online response |
Yes |
|
NAMDEB Medical Scheme |
NAM0101 |
R15.00 per Item |
4-6, 15, 19, 21-25, 27, 31-32, 38, 40-41, 43-45, 50-51, 61-62 |
||
|
NAPOTEL Medical Aid Fund |
NAM0102 |
20% (min R35.00 max R60.00 per Rx) |
3-9, 11, 15, 17, 19, 22-25, 27, 31-32, 44, 61-62 |
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RCC Medical Aid Scheme |
NAM0103 |
15% |
1-11, 15, 17, 19, 22-25, 27,
31-35, 44-45, 58, 61-62 |
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Renaissance Health Medical Aid
Fund (RHMAF) |
NAM0104 |
15% (min R25.00 per Rx) |
2, 4-5, 15, 21-27, 31-32, 35,
44-45, 58, 60-61 |
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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:
Mediscor’s Call Centre :
0860 113 238 or 0860 117 705
Mediscor ChroniLine
(Pre-authorisation / Chronic) : 0860
119 553
Prosperity Health Namibia : + 264 (61) 299 9000
Kind regards
JACK PEREL