MEDISCOR (PTY) LTD 1257 South Street, Centurion PO Box 8796, Centurion, 0046 Tel: (012) 674 8000 Fax: (012) 674 8001	NOTIFICATION 49 OF 2011
		22 December 2011

Medical Scheme	Nampak SA Medical Scheme
Administrator	Momentum Medical Scheme Administrators
Information Relevant to	Benefits and Options for 2012
Effective Date	1 January 2012

With effect 1 January 2012, Mediscor will be applying the scheme rules for Nampak SA Medical Scheme as outlined below.

Herewith the detail for submitting medicine claims to Mediscor:

1.	Scheme Code (PCN)	1.	MDS0043
2.	Switch Destination Code	2.	NMAK0000
3.	EDI Activation Code (Dispensing Doctors)	3.	046P
4.	Reference Pricing	4.	Yes
5.	Maximum supply of medicine	5.	30 Days
6.	Days supply of the dispensed medicine	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 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 diagnosis code	13.	Yes / Compulsory
14.	9 digit NAPPI code of medicine dispensed	14.	Yes / Compulsory
15.	Membership number requirements	15.	Minimum 4 numerical including dependant code
16.	Payments to Providers	16.	NAMPAK
17.	Chronic pre-authorisation	17.	NAMPAK
18.	Reimbursement structure – Dispensing Doctors	18.	SEP + 30%/R23.40
19.	Reimbursement structure – Pharmacies	19.	SEP + 28%/R28
20.	Over the counter (OTC)	20.	SEP + 28%/R28

· SEP (VAT Incl.) and dispensing fee (VAT Excl.)

· Reimbursement structure will be applied on scheduled medicines (0 – 8) and unscheduled products.

· 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 Nampak SA Medical Scheme effective from 1 January 2012:

OPTIONS	BENEFITS APPLICABLE	LEVY / CO-PAYMENT	MMAP©	EXCLUSIONS
Extended	Chronic	Non-formulary 10%	Yes	3-5, 14, 15, 24, 25, 27, 30-32, 35, 45, 53, 61
	Acute / Savings	No Levy	No
	PMB	Non-formulary 10%	Yes
	OTC	No Levy Maximum of R80 per prescription	No
	HIV/Aids	No Levy
	Appliance	No Levy
	Oncology	No Levy
	Homeopathic	No Levy
	Flu Vaccines	No Levy Maximum of R75 per prescription
Standard	Acute / Savings	No Levy	Yes	1-5, 7, 11, 14-16, 19, 20, 22-25, 27, 30-32, 35, 40, 41, 43-45, 49-51, 53, 55, 57, 58, 61
	Chronic	Non-formulary 10%
	PMB	Non-formulary 10%
	OTC	No Levy Maximum of R80 per prescription
	HIV/Aids	No Levy	No
	Oncology	No Levy
	Appliance	No Levy	Yes
	Homeopathic	No Levy
	Flu Vaccines	No Levy Maximum of R75 per prescription	No

CLINICAL DUR CHECKS APPLIED TO ALL CLAIMS

(Please check the on-line response)

· Drug to drug interactions (Informational)

· Drug to diagnosis/disease (Reject)

· Dosage range check (Reject)

· Drug to age checking (Reject)

· Drug to gender (Reject)

· Duplicate therapy (Informational)

· Duplicate ingredient (Reject)

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
NAMPAK Helpline	:	0860 101 047
HIV/AIDS – NAMPAK Your Life	:	0860 109 793

Kind regards.

JACK PEREL