|
|
MEDISCOR (PTY) LTD |
NOTIFICATION
45
OF
2008 |
9 December 2008
|
|
Medical Scheme |
Malcor Medical Scheme |
|
Administrator |
Allcare Administrators |
|
Information Relevant to |
Benefits and Options for
2009 |
|
Effective Date |
1 January 2009 |
With effect 1 January 2009, Mediscor will be applying the scheme rules
for MALCOR Medical Scheme as outlined below.
Herewith
the details for submitting medicine claims to Mediscor:
|
1. |
Scheme
Code (PCN) |
1. |
MDS0003 |
|
2. |
Switch
Destination Code |
2. |
NMMD0000 |
|
3. |
EDI
Activation Code (Dispensing Doctors) |
3. |
104P |
|
4. |
MMAP© |
4. |
Yes |
|
5. |
Maximum
supply of medicine |
5. |
30 Days |
|
6. |
Days of
supply of the dispensed medication |
6. |
Yes
/Compulsory |
|
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 |
|
12. |
Practice
number of the prescriber |
12. |
Yes /
Compulsory |
|
13. |
ICD-10
Diagnostic code |
13. |
Yes /
Compulsory |
|
14. |
9 digit
NAPPI code of medicine dispensed |
14. |
Yes /
Compulsory |
|
15. |
Membership
number requirements |
15. |
7
Numerical |
|
16. |
Payments
to Providers |
16. |
Allcare |
|
17. |
Chronic/PMB
pre-authorisation at Mediscor |
17. |
Yes |
|
18. |
Reimbursement
structure – Dispensing Doctors |
18. |
SEP +
R16/16% |
|
19. |
Reimbursement
structure – Pharmacies |
19. |
SEP +
R26/26% |
|
20. |
Schedule
0 or Unscheduled |
20. |
SEP + max
mark-up of 26% (VAT Excl.) |
* MEDISCOR FORMULARIES – information available on
www.mediscor.net
* 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 Scheme rules for MALCOR effective from 1 January 2009:
|
OPTIONS |
BENEFIT STRUCTURE |
LEVY / |
MMAP© |
EXCLUSIONS |
|
Plan B Plan C |
Acute |
No levy |
Yes |
1-5,11,21-25,27,30-32,
38,40-41,43-45,50,55, 58,60-62 |
|
Chronic |
No Levy |
|||
|
OTC |
No levy – part of acute |
|||
|
Surgical |
No levy |
|||
|
Psychiatric
Benefit |
No levy |
|||
|
Prescribed
Minimum Benefits (PMBs) |
Mediscor Extended Formulary: Malcor A: Formulary
products: No Levy Non-formulary
products: N/A
Malcor B: Formulary
products: No Levy Non-formulary
products: Malcor B - Pay from acute
Mediscor Basic Formulary: Malcor C: Formulary
products: No Levy Non-formulary
products: Malcor C - Pay from
savings |
|||
|
Oncology |
No Levy |
|||
|
Radiology |
No Levy |
Pre-authorised
products will allow 1 refill every 26 days.
PRESCRIBED
MINIMUM BENEFITS (PMBs) – Mediscor Basic, Standard and Extended Formularies:
Members need to apply for PMBs
and Chronic Medicine Benefits with Mediscor ChroniLine™ on
0860 119 553.
If
you require any assistance, please contact:
|
Mediscor’s Toll-free Call Centre Helpline |
: |
0860 113 238 or 0860 117 705 |
|
Mediscor ChroniLine™ |
: |
0860 119 553 |
Kind
regards.
JACK
PEREL