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MEDISCOR
(PTY) LTD |
NOTIFICATION 53OF2010 |
Date: 14 December 2010
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Medical Scheme |
Prosperity Health
Namibia – All Schemes 1.
NAMDEB 2.
Renaissance Health Medical Aid Fund (RHMAF) 3.
NAPOTEL 4.
Road Contractors Company 5.
Prosperity Life |
|
Administrator |
Prosperity Health
Namibia |
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Information Relevant to |
Benefits and Options
for 2011 – All Namibian Pharmacies |
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Effective Date |
1 January 2011 |
With effect 1 January 2011, Mediscor will be applying the scheme rules
for the following PROSPERITY HEALTH NAMIBIA SCHEMES as outlined below.
To facilitate the electronic submission Mediscor has only contracted MediSwitch Namibia. Therefore all claims must be sent to
Mediscor via MediSwitch Namibia and NO transaction
fees will be charged to pharmacies.
Herewith the detail for submitting medicine claims to
Mediscor:
|
1. |
Scheme Code –
Prosperity Namibia All Schemes |
1. |
NAM0100 |
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2. |
MediSwitch Namibia Destination Code |
2. |
RHMS0001
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|
3. |
NAMIBIAN
Mediscor Reference Price (NRP) |
3. |
YES |
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4. |
EDI Activation
Code (Dispensing Doctors) |
4. |
No |
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5. |
Maximum supply
of medicine |
5. |
30 Days |
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6. |
Days of supply
of the dispensed medication |
6. |
Yes /Compulsory |
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7. |
Membership
number as per membership card |
7. |
Yes / Compulsory |
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8. |
Dependant code
as per membership card |
8. |
Yes / Compulsory |
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9. |
Dependant
first name as per the membership card |
9. |
Yes / Compulsory |
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10. |
Dependant date
of birth |
10. |
Yes /Compulsory |
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11. |
Dependant’s
gender (male/female) |
11. |
Yes / Compulsory |
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12. |
Practice
number of the prescriber |
12. |
Yes / Compulsory |
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13. |
9 digit NAPPI
code of medicine dispensed |
13. |
Yes / Compulsory |
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14. |
ICD-10
Diagnostic code |
14. |
NO |
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15. |
Membership
number requirements |
15. |
7 Numerical
|
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16. |
Payments to Providers |
16. |
Prosperity Health Namibia |
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17. |
Chronic pre-authorisation |
17. |
Mediscor – ChroniLineTM |
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18. |
Reimbursement structure –
Pharmacies |
18. |
SEP + 50% + N$4.50 +
broken bulk + container fee + 15% TAX |
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19. |
Reimbursement structure – Pharmacies
HIV for NAMDEB only. |
19. |
SEP + N$75.00 + broken
bulk + container fee + 15% TAX |
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20. |
Reimbursement structure –
Doctors |
20. |
SEP + 50% + broken bulk +
container fee + 15% TAX |
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Individual Scheme codes |
MediSwitch
Namibia (Destination code) |
Mediscor
Scheme Code |
|
Prosperity Health Namibia All Schemes |
RHMS0001 |
NAM0100 |
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1. NAMDEB Medical Scheme |
NAM0101 |
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2. NAPOTEL Medical Aid Fund |
NAM0102 |
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3. Road
Contractors Company
(RCC) Medical Aid Fund |
NAM0103 |
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4. Renaissance Health Medical Aid Fund (RHMAF) |
NAM0104 |
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5. Prosperity
Life Medical Aid Fund |
NAM0105 |
Herewith the Scheme rules for PROSPERITY HEALTH
NAMIBIA effective from
1 January 2011:
|
SCHEME |
Mediscor
Scheme Code (PCN) |
MediSwitch Destination Code |
LEVY |
EXCLUSIONS |
NRP |
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Prosperity Health Namibia - All Schemes |
NAM0100 |
RHMS0001 |
As per online response |
As per online response |
Yes |
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NAMDEB |
NAM0101 |
N$15.00 per Item |
4-6, 15, 19,
21-25, 27, 31-32, 38, 40-41, 43-45, 50-51, 61-62 |
||
|
NAPOTEL |
NAM0102 |
20% (min N$35.00 max N$60.00 per Rx) |
3-9, 11, 15, 17,
19, 22-25, 27, 31-32, 44, 61-62 |
||
|
Road Contractors Company |
NAM0103 |
15% |
1-11, 15, 17, 19, 22-25, 27, 31-35, 44-45, 58, 61-62 |
||
|
Renaissance Health Medical Aid
Fund (RHMAF) |
NAM0104 |
15% (min N$25.00 per Rx) |
2, 4-5, 15, 21-27, 31-32, 35, 44-45, 58, 60-61 |
||
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Prosperity Life |
NAM0105 |
As per online response |
1-6, 15, 19, 20-27, 31-35, 42, 44-45, 57-58, 60-62 |
Authorisation for the treatment of HIV
/ AIDS:
|
Mediscor ChroniLineTM |
(061) 299
9991 |
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Mediscor ChroniLineTM |
(061) 299
9991 |
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Mediscor ChroniLineTM |
(061) 299
9991 |
|
AFA AFA |
(061) 285
5423 (061) 285
5423 |
IF
YOU REQUIRE ANY ASSISTANCE, PLEASE CONTACT:
Claim & Client
Services
: (061) 299 9990
MediSwitch Namibia : 0800 112 233
Pre-authorisation /
Chronic (Mediscor ChroniLineTM) : (061)
299 9991
Pre-authorization
email
: preauth@na.prosperityhealth.com
Mediscor PBM (South
Africa) : +27 12 674 8000
Kind regards
JACK PEREL