|
|
MEDISCOR
(PTY) LTD |
NOTIFICATION 44OF2011 |
20
December 2011
|
|
Medical Scheme |
Medicross |
|
Administrator |
Medicross |
|
Information Relevant to |
Medicross Capitation
Benefits and Options for 2012 |
|
Effective Date |
1 January 2012 |
With effect 1
January 2012, Mediscor will be applying the scheme rules for Medicross scheme
options as outlined below.
·
The Medicross Formulary will be applied.
·
The Medicross provider and prescriber
network rules will apply.
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. |
Reference Pricing |
3. |
Yes |
|
4. |
Maximum supply of medicine |
4. |
30 Days |
|
5. |
Days supply of the
dispensed medicine |
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 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 Diagnosis 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 |
15. |
Mediscor ChroniLine™ |
|
16. 17. |
Reimbursement structure -
Pharmacies Reimbursement structure – Dispensing
Doctors |
16. 17. |
SEP + 26%/R26 (All
Schedules) SEP + 30%/R20 (All
Schedules) |
|
18. |
Over the counter (OTC) |
18. |
No |
·
SEP
(VAT Incl.) and dispensing fee (VAT Excl.)
·
Reimbursement
structure will be applied on scheduled medicines (0 – 8) and unscheduled products.
·
Medicross acute formulary
– information available on www.primecure.co.za
·
Mediscor Reference Price (MRP®) – information available on 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.
If you require any assistance, please contact:
|
Mediscor’s
Call Centre |
: |
0860 113 238
or 0860 117 705 |
|
||
|
Mediscor
ChroniLine™ Mediscor
E-Mail |
: : |
0860 119 553 |
|
||
|
|
|
|
|||
Kind regards
JACK PEREL