|
|
MEDISCOR
(PTY) LTD |
NOTIFICATION 46OF2011 |
21
December 2011
|
|
Medical Insurance Fund |
CIGNA SVS (MSO
International) |
|
Administrator |
Medical
Services Organisation (MSO) |
|
Information Relevant to |
Benefits
and Options for 2012 |
|
Effective Date |
1
January 2012 |
With effect 1 January
2012, Mediscor will be applying the medicine claim rules for MSO International medical
insurance fund (CIGNA SVS), as outlined below.
Herewith
the detail for submitting medicine claims to Mediscor:
|
1. |
Scheme
Code (PCN) |
MDS0069 |
|
2. |
Switch
Destination Code |
MINT0001 |
|
3. |
Reference
pricing |
Yes |
|
4. |
Maximum
supply of medicine |
30
Days |
|
5. |
Days
supply of the dispensed medicine |
Yes
/Compulsory |
|
6. |
Membership
number as per membership card |
Yes
/ Compulsory |
|
7. |
Dependant code as per membership card |
Yes
/ Compulsory |
|
8. |
Dependant first name as per membership card |
Yes
/ Compulsory |
|
9. |
Dependant date of birth |
Yes
/Compulsory |
|
10. |
Dependant’s gender (male/female) |
Yes
/ Compulsory |
|
11. |
Practice
number of the prescriber |
Yes
/ Compulsory |
|
12. |
ICD-10
diagnosis code |
Yes
/ Compulsory |
|
13. |
9
digit NAPPI code of medicine dispensed |
Yes
/ Compulsory |
|
14. |
Membership
number requirements |
Minimum
6 numerical excluding dependant code |
|
15. |
Payments
to Providers |
MSO
International |
|
16. |
Reimbursement
structure (Schedule 0 – 8) Pharmacies |
Legislated
4 TIER (Max) |
|
17. |
Reimbursement
structure (Unscheduled) Pharmacies |
SEP
+ max mark-up of 31% |
·
SEP
(VAT Incl.) and Dispensing Fee (VAT Excl.)
·
Legislated
4 TIER reimbursement structure will be applied on Schedule 0 to 8 medicine
claims – information available on www.mediscor.net/publications.html
·
Mediscor Reference Price (MRP®) – 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 and Exclusion criteria; service providers must refer to our on-line responses
to apply the correct rules.
Herewith the medicine rules for MSO International
effective from 1 January 2012:
|
FUND |
BENEFITS APPLICABLE |
LEVY |
MRP® |
EXCLUSIONS |
|
CIGNA
SVS |
All benefits |
No levies applicable |
Yes |
N/A |
If you require any assistance, please contact:
|
Mediscor’s Call Centre Mediscor
E-Mail |
:
0860 113 238 or 0860 117 705 :
helpdesk@mediscor.co.za |
|
MSO
International (CIGNA SVS) |
:
011-259 5101 |
|
|
|
Kind regards.
JACK PEREL