|
|
MEDISCOR
(PTY) LTD |
NOTIFICATION 52OF2010 |
10
December 2010
|
|
Medical Scheme |
Prime Cure |
|
Administrator |
Prime Cure |
|
Information Relevant to |
Prime Cure Capitation
Benefits and Options for 2011 |
|
Effective
Date |
1 January 2011 |
With effect 1 January 2011, Mediscor will be applying the scheme
rules for Prime Cure scheme options as outlined below.
·
Prime Cure provider and prescriber network rules
will apply.
·
The Prime Cure Formulary will be applied.
Herewith the detail for submitting medicine claims to
Mediscor:
|
1. |
Scheme Code (PCN) |
1. |
As per list below / MDS0300
|
|
2. |
Switch Destination Code |
2. |
PCUR0001 |
|
3. |
EDI Activation Code
(Dispensing Doctors) |
3. |
642P |
|
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. |
Payments to Providers |
15. |
Prime Cure
|
|
16. |
Chronic/PMB
pre-authorisation at Mediscor |
16. |
Yes - Mediscor ChroniLine™ |
|
17. |
Reimbursement structure –
Pharmacies |
17. |
SEP + R26/26%
|
|
18. |
Reimbursement structure –
Dispensing Doctors |
18. |
SEP + R20/30%
|
|
19. |
Reimbursement structure –
Schedule 0 or Unscheduled Medicine |
19. |
SEP + max mark-up of 31%
(Excl. VAT)
|
|
20. |
OTC Claims |
20. |
Yes - Selected Options
|
·
MEDISCOR
REFERENCE PRICE (MRP®) – information available on www.mediscor.net
·
PRIME
CURE CHRONIC/PMB FORMULARY – information available on www.mediscor.net
·
PRIME
CURE ACUTE FORMULARY – information available on www.primecure.co.za or www.mediscor.net
·
ICD-10
CODES – information available on www.medicalschemes.com
MEDICAL SCHEME
OPTIONS CONTRACTED TO PRIME CURE: 2011
|
MEDICAL SCHEME |
PRIME CURE OPTION |
SCHEME CODE |
|
Anglomed |
Value Care |
MDS0353 |
|
BESTmed |
Blueprint |
MDS0302 |
|
Bonitas |
Boncap |
MDS0344 |
|
Eyethumed |
Prime Cure |
MDS0305 |
|
Furnmed |
Prime Cure |
MDS0306 |
|
G4S |
G4S |
MDS0349 |
|
Goldfields Medical Scheme |
Pride |
MDS0354 |
|
Minemed |
Affordable |
MDS0342 |
|
Momentum Health |
Access Option |
MDS0355 |
|
Momentum Health |
Ingwe Option |
MDS0355 |
|
Suremed |
Explorer |
MDS0347 |
|
SureOne |
Commair |
MDS0336 |
|
Thlakano |
Basic Option |
MDS0356 |
|
Thlakano |
Comprehensive |
MDS0356 |
|
Thlakano |
LegalWise |
MDS0356 |
|
Thlakano |
MBD |
MDS0356 |
|
Thlakano |
MBP - Health |
MDS0356
|
|
Thlakano |
MDB – Essential-life |
MDS0356 |
|
Thlakano |
St Davids |
MDS0356 |
|
Thlakano |
Mahala |
MDS0356 |
|
Transmed |
State + Network |
MDS0317 |
|
Umvuzo Health |
Ultra Affordable |
MDS0331 |
|
Umvuzo Health |
Umvuzo Standard |
MDS0331 |
|
World Vision |
World Vision |
MDS0348 |
|
Prime Cure All
Scheme |
Prime Cure All
Scheme |
MDS0300 |
PLEASE
NOTE THAT THE FOLLOWING PRIME CURE SCHEME OPTIONS HAVE
BEEN
DISCONTINUED FOR 2011.
|
MEDICAL SCHEME |
PRIME CURE OPTION |
SCHEME CODE |
|
Gen-Health |
Primary Cover |
MDS0350 |
|
Ingwe Health Plan |
Ingwe Capitation |
MDS0308 |
|
Ingwe Health Plan |
Medicare |
MDS0308 |
|
Ingwe Health Plan |
Pioneer |
MDS0308 |
|
Liberty |
Corporate Network Option |
MDS0345 |
|
Medihelp |
Necesse |
MDS0352 |
|
Prosano |
Procedure |
MDS0324 |
|
Sizwe |
Affordable Network Option |
MDS0351 |
|
SureOne |
Dunn Stores |
MDS0336 |
PLEASE
NOTE THAT THE FOLLOWING PRIME CURE SCHEME OPTION CODES
HAVE
BEEN CHANGED FOR 2011.
|
MEDICAL SCHEME |
PRIME CURE OPTION |
SCHEME CODE(OLD) |
SCHEME CODE (NEW) |
|
Anglomed |
Value Care |
MDS0301 |
MDS0353 |
|
Goldfields Medical Scheme |
Pride |
MDS0341 |
MDS0354 |
|
Momentum |
Access Option |
MDS0322 |
MDS0355 |
|
Momentum |
Ingwe Option |
MDS0322 |
MDS0355 |
|
Thlakano |
Basic Option |
MDS0339 |
MDS0356 |
|
Thlakano |
Comprehensive |
MDS0339 |
MDS0356 |
|
Thlakano |
LegalWise |
MDS0339 |
MDS0356 |
|
Thlakano |
MBD |
MDS0339 |
MDS0356 |
|
Thlakano |
MBP-Health |
MDS0339 |
MDS0356 |
|
Thlakano |
MDB-Essential-life |
MDS0339 |
MDS0356 |
|
Thlakano |
St Davids |
MDS0339 |
MDS0356 |
|
Thlakano |
Mahala |
MDS0339 |
MDS0356 |
If you require any assistance, please contact:
|
Mediscor’s Call Centre Helpline |
: |
086 011 3238 or 086 011 705 |
Kind regards.
JACK PEREL