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|
MEDISCOR (PTY) LTD |
NOTIFICATION
54
OF
2008 |
15 December 2008
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|
Medical
Scheme |
Prosperity Health Namibia – All Schemes 1.
NAMDEB 2.
RENAISSANCE Namibia 3.
NAPOTEL 4.
Road Contractors Company 5.
Prosperity Life |
|
Administrator |
Prosperity Health Namibia |
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Information
Relevant to |
Benefits and Options for 2009 – All South African
Pharmacies |
|
Effective
Date |
1 January 2009 |
With
effect 1 January 2009, Mediscor will be applying the scheme rules for the
following PROSPERITY HEALTH NAMIBIA SCHEMES as outlined below.
Herewith
the details for submitting medicine claims to Mediscor:
|
1. |
Scheme Code – Prosperity Namibia All
Schemes |
1. |
NAM0100 |
|
2. |
MediSwitch Namibia Destination Code |
2. |
RHMS0001
|
|
3. |
NAMIBIAN
Mediscor Reference Price (NMRP) |
3. |
YES |
|
4. |
EDI Activation Code (Dispensing Doctors) |
4. |
No |
|
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. |
9 digit NAPPI code of medicine dispensed |
13. |
Yes / Compulsory |
|
14. |
ICD-10 Diagnostic code |
14. |
NO |
|
15. |
Membership number requirements |
15. |
7 Numerical
|
|
16. |
Payments
to Providers |
16. |
Prosperity
Health Namibia |
|
17. |
Chronic pre-authorisation |
17. |
Mediscor
– ChroniLine |
|
18. |
Reimbursement structure – Pharmacies |
18. |
SEP 26% / R26.00 |
|
19. |
Reimbursement structure – Schedule 0 and Unscheduled
Medicines |
19. |
SEP + 31% (Excl. VAT) |
Herewith the Scheme rules for PROSPERITY HEALTH
NAMIBIA effective from 1 January 2009:
|
SCHEME |
Mediscor Scheme Code (PCN) |
MediSwitch Destination Code |
LEVY |
EXCLUSIONS |
NMRP |
|
Prosperity Health Namibia - All Schemes |
NAM0100 |
RHMS0001 |
As per online response |
As per online response |
Yes |
|
NAMDEB |
NAM0101 |
R5,00 per Item |
4-6, 15, 19, 21-25,
27,28, 31-32, 38, 40-41, 43-45, 50-51, 61-62 |
||
|
NAPOTEL |
NAM0102 |
20% (min R25,00 max R50,00 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 (Prosperity) |
NAM0104 |
15% (min R25.00 per Rx) |
2, 4-6, 15, 21-27, 31-32, 35, 44-45, 58, 60-62 |
||
|
Prosperity Life |
NAM0105 |
As per online response |
1-6, 15, 19, 20-27, 31-35, 42, 44-45, 57-58, 60-62 |
IF YOU REQUIRE ANY ASSISTANCE, PLEASE
CONTACT:
Mediscor’s Share Call Centre Help Line : 0860 113 238 or 0860 117 705
Mediscor ChroniLine (Pre-authorisation / Chronic) : 0860
119 553
Prosperity
Health Namibia : + 264 (061) 299 9000
Kind
regards
JACK
PEREL