|
|
MEDISCOR
(PTY) LTD |
NOTIFICATION 41OF2009 |
15/12/2009
|
|
Medical Scheme |
Medicross |
|
Administrator |
Medicross |
|
Information Relevant to |
Medicross Capitation Benefits and
Options for 2010 |
|
Effective Date |
1 January 2010 |
With effect 1
January 2010, Mediscor will be applying the scheme rules for Medicross scheme options as outlined below.
·
The Medicross
Formulary will be applied.
Herewith the detail for submitting medicine claims to
Mediscor:
|
1. |
Scheme Code (PCN) |
1. |
As per list below /
MDM0000 |
|
2. |
Switch Destination Code |
2. |
MCAP0001
|
|
3. |
MRP® |
3. |
Yes |
|
4. |
Maximum supply of medicine |
4. |
30 Days |
|
5. |
Days of supply of the
dispensed medication |
5. |
Yes /Compulsory |
|
6. |
Membership number as per
membership card |
6. |
Yes / Compulsory |
|
7. |
Dependant code as per
membership card |
7. |
Yes / Compulsory |
|
8. |
Dependant first name as
per the membership card |
8. |
Yes / Compulsory |
|
9. |
Dependant date of birth |
9. |
Yes /Compulsory |
|
10. |
Dependant’s gender
(male/female) |
10. |
Yes / Compulsory |
|
11. |
Practice number of the
prescriber |
11. |
Yes / Compulsory |
|
12. |
ICD-10 diagnostic code |
12. |
Yes / Compulsory |
|
13. |
9 digit NAPPI code of
medicine dispensed |
13. |
Yes / Compulsory |
|
14. |
Payments to Providers |
14. |
Medicross |
|
15. |
Chronic/PMB
pre-authorisation at Mediscor |
15. |
Yes – Mediscor ChroniLine™ |
|
16. |
Reimbursement structure -
Pharmacies |
16. |
SEP + R26/26% |
|
17. |
Reimbursement structure –
Schedule 0 or Unscheduled Medicine |
17. |
SEP + max mark-up of 31%
(Excl. VAT) |
|
18. |
OTC |
18. |
Yes – Selected Options |
·
MEDISCOR REFERENCE PRICE (MRP®) – information available on
www.mediscor.net
·
MEDICROSS CHRONIC/PMB FORMULARY – information available on www.mediscor.net
·
MEDICROSS 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 MEDICROSS:
|
MEDICAL SCHEME |
MEDICROSS OPTION |
SCHEME CODE |
|
Momentum Health |
Access Option |
MDM0021 |
Medicross All Scheme
|
Medicross All Scheme
|
MDM0000
|
Should the patient not know on which benefit/plan
option he/she is, then the Medicross All scheme claiming
code (MDM0000) can be used.
PLEASE NOTE THAT THE FOLLOWING SCHEME OPTIONS
HAVE BEEN DISCONTINUED FOR 2010:
|
MEDICAL SCHEME |
MEDICROSS OPTION |
SCHEME CODE |
|
CAMAF |
Network Choice |
MDM0030 |
|
Ingwe |
Medicap Option |
MDM0003 |
|
PUREhealth |
Purenetwork |
MDM0031
|
|
Telemed |
Gold Select |
MDM0032 |
If you require any assistance, please contact:
|
Mediscor’s Call Centre Helpline |
: |
086 011 3238
or 086 011 7705 |
Kind regards
JACK PEREL