|
|
MEDISCOR (PTY) LTD |
NOTIFICATION
50
OF
2008 |
11 December 2008
|
|
Medical Scheme |
Clicks Medical Scheme |
|
Administrator |
Old Mutual Health Care |
|
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 Clicks
Medical Scheme as outlined below.
Herewith
the details for submitting medicine claims to Mediscor:
|
1. |
Scheme
Code (PCN) |
1. |
MDS0028
|
|
2. |
Switch
Destination Code |
2. |
CLIC0001 |
|
3. |
EDI
Activation Code (Dispensing Doctors) |
3. |
No |
|
4. |
MRP® |
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. |
Maximum 10 characters |
|
16. |
Payments
to Providers |
16. |
Mediscor |
|
17. |
Chronic/PMB
pre-authorisation at Mediscor |
17. |
Yes |
|
18. |
Reimbursement
structure – Pharmacy |
18. |
SEP +
R26/26% |
|
19. |
Reimbursement
structure – Dispensing Doctors |
19. |
SEP +
R16/16% |
|
20. |
Reimbursement
structure – Unscheduled and Schedule 0 Medicine |
20. |
SEP + 31%
(Excl. VAT) |
* MEDISCOR
REFERENCE PRICE (MRP®) – information available on www.mediscor.net
* 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 Clicks Medical Scheme
effective from 1 January 2009:
|
OPTION |
BENEFITS
APPLICABLE |
LEVY /
CO-PAYMENT |
MRP® |
EXCLUSIONS |
|
ALL Options |
Acute |
No Levy |
Yes |
1-5,7-10,15,19,20 ,22-32,
39-41, 43-45,47,48,50, 51,58,61,62 |
|
Chronic |
||||
|
OTC |
||||
|
Prescribed Minimum
Benefits (PMB) |
Mediscor
Standard Formulary: ALL Options: Formulary product = No
levy Non-Formulary products =
25% co-payment |
PRESCRIBED
MINIMUM BENEFITS (PMBs):
Members
need to apply and register for PMBs and Chronic Medicine Benefits with Mediscor
ChroniLine™ on 0860 119 553.
If
you require any assistance, please contact:
|
Mediscor’s Share Call Centre Helpline |
: |
0860 113 238 or 0860 117 705 |
|
Mediscor ChroniLine™ |
: |
0860 119 553 |
Kind
regards.
JACK
PEREL