Description: New Mediscor logo with slogan

 

MEDISCOR (PTY) LTD
1257 South Street, Centurion
PO Box 8796, Centurion, 0046
Tel:   (012) 674 8000
Fax:  (012) 674 8001

 

NOTIFICATION 4
OF
 2012

 

 

 30 July 2012

 

Medical Scheme

Seventh-day Adventist Medical Scheme (SEDMED)

Administrator

SEDMED

Information Relevant to

New Mediscor Medical Scheme

Effective Date

1 August 2012

 

Situated in Bloemfontein, SEDMED is a well-established medical aid scheme registered with the Council for Medical Schemes since February, 1987. SEDMED specifically covers the employees of the Seventh-day Adventist Church in South Africa, Namibia and Lesotho.

 

With effect 1 August 2012, Mediscor will be applying the medicine claim rules for SEDMED Medical Scheme, for South Africa pharmacies only, as outlined below. All claims with service date from 1 May 2012 may be submitted via Mediscor.

 

Herewith the detail for submitting medicine claims to Mediscor:

 

1.

Scheme Code (PCN)

MDS0074

2.

Switch Destination Code

SMSC0003

3.

EDI Activation Code (Dispensing Doctors)

022P

4.

Reference pricing (MRP®)

Not Applicable

5.

Maximum supply of medicine

30 Days

6.

Days supply of the dispensed medicine

Yes /Compulsory

7.

Membership number as per membership card

Yes / Compulsory

8.

Dependant code as per membership card

Yes / Compulsory

9.

Dependant first name as per membership card

Yes / Compulsory

10.

Dependant date of birth

Yes /Compulsory

11.

Dependant’s gender (male/female)

Yes / Compulsory

12.

Practice number of the prescriber

Yes / Compulsory

13.

ICD-10 Diagnosis code

Yes / Compulsory

14.

9 digit NAPPI code of medicine dispensed

Yes / Compulsory

15.

Membership number requirements

Minimum 5 numerical

16.

Payments to Providers

SEDMED Medical Scheme

17.

Chronic pre-authorisation

SEDMED Medical Scheme

18.

Reimbursement structure – SA Pharmacies

Legislated 4 TIER on all claims

 

·         Legislated 4 TIER reimbursement structure will be applied on all pharmacy claims – information available on www.mediscor.net/publications.html (Government Gazette No33775)

·         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 rules for SEDMED Medical Scheme effective from 1 August 2012:

  


OPTIONS

BENEFITS APPLICABLE

LEVY

REFERENCE PRICE (MRP®)

EXCLUSIONS

 

 

 

 

SEDMED

Acute

25% Levy

N/A

 

 

3,4,5,7,11,14,15,19

20,21,22,23,24,25,27,

30,31,32,45,53,60,61

 

 

 

Chronic

20% Levy

N/A

PMB

No levies applicable

N/A

HIV/AIDS

No levies applicable

N/A

Organ Transplant

No levies applicable

N/A

Oncology

No levies applicable

N/A

OTC

25% Levy

N/A

 

 

MEDICINE AUTHORISATION:
 
Members and Providers must apply for medicine authorisations with SEDMED Medical Scheme on 051 447 8991.
 

 

If you require any assistance, please contact:

Mediscor’s Contact Centre

Mediscor E-mail

SEDMED Medical Scheme

:

:

:

0860 113 238 or 0860 117 705

helpdesk@mediscor.co.za

051 447 8991

 

Kind regards.

ILSE STEYN