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|
MEDISCOR
(PTY) LTD |
NOTIFICATION 56OF2011 |
23
December 2011
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|
Medical Scheme |
Momentum Africa Medical
Schemes |
|
Administrator |
Momentum
Africa |
|
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 Momentum Africa Medical Schemes as outlined
below.
Herewith the detail for submitting
medicine claims to Mediscor:
|
1. |
Scheme Code
(PCN) |
1. |
MDS0063 |
|
2. |
Switch
Destination Code |
2. |
MHAF0001
|
|
3. |
EDI Activation
Code (Dispensing Doctors) |
3. |
N/A
|
|
4. |
Reference
Pricing |
4. |
No |
|
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. |
9 digit NAPPI
code of medicine dispensed |
13. |
Yes / Compulsory |
|
14. |
ICD-10 Diagnosis
code |
14. |
Yes / Compulsory |
|
15. |
Membership
number requirements |
15. |
Minimum 4
Numerical including dependant code |
|
16. |
Payments to
Providers |
16. |
Momentum Africa |
|
17. |
Chronic
pre-authorisation |
17. |
Momentum Africa |
|
18. |
Reimbursement
structure – Pharmacies |
18. |
S0 to S8: SEP
+ 26%/R26 |
|
19. |
Reimbursement structure – Unscheduled
medicine |
19. |
SEP +
31% |
- SEP (VAT
Incl.) and Dispensing Fee (VAT Excl.)
·
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 Momentum Africa
Medical Scheme effective from 1 January 2012:
Schemes & options:
- Momentum
Botswana: Botsogo Health Plan
- Momentum Ghana: Mutual Alliance
- Momentum Lesotho: Bophelo Medical Scheme
- Momentum Mauritius: Bonne Sante Health Plan
- Momentum Mocambique: P’La Saude Health Plan
- Momentum Tanzania: Imara Health Plan
- Momentum Zambia: Wanthanzi Health Plan
|
OPTIONS |
BENEFITS APPLICABLE |
LEVY / CO-PAYMENT |
MMAP© |
EXCLUSIONS |
|
Momentum Africa |
Acute |
No Levy |
No |
1-7; 10; 11; 14-17; 19-27; 30-35; 41; 43-48;
50-53; 57; 58; 60-62 |
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Chronic |
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HIV/Aids |
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Appliance |
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Organ Transplant |
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Oncology |
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 |
Kind regards.
JACK PEREL