|
|
MEDISCOR (PTY) LTD |
NOTIFICATION 62
OF
2008 |
18 December 2008
|
|
Medical
Scheme |
Prime Cure |
|
Administrator |
Prime Cure |
|
Information
Relevant to |
Prime Cure Capitation Benefits and Options for
2009 |
|
Effective Date |
1 January 2009 |
With effect 1 January 2009,
Mediscor will be applying the scheme rules for Prime Cure scheme options
as outlined below.
·
Only prescriptions written by a Prime Cure Contracted Physician or
Specialist will be accepted.
·
The Prime Cure Formulary will be applied.
Herewith the details 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 + 26% / R26.00
|
|
18. |
Reimbursement structure –
Dispensing Doctors |
18. |
SEP + 16% / R16.00
|
|
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
* ICD-10 CODES – information available on
www.medicalschemes.com
Herewith a
summary of Medical Scheme Options Contracted to Prime Cure:
MEDICAL SCHEME OPTIONS CONTRACTED TO PRIME CURE:
|
MEDICAL
SCHEME |
PRIME
CURE OPTION |
SCHEME
CODE |
|
Anglo Medical Scheme |
Value Care |
MDS0301 |
|
BESTmed |
Blueprint |
MDS0302 |
|
Bonitas |
Boncap |
MDS0344 |
|
Eyethumed |
Prime Cure |
MDS0305 |
|
Furnmed |
Prime Cure |
MDS0306 |
|
G4S |
G4S |
MDS0349 |
|
Gen-Health (New) |
Primary Cover (New) |
MDS0350 |
|
Goldfields Medical Scheme |
Pride |
MDS0341 |
|
Ingwe Health Plan |
Ingwe Capitation |
MDS0308 |
|
Ingwe Health Plan |
Pioneer |
MDS0308 |
|
Key Health |
Key Cap |
MDS0333 |
|
Laundry Bargaining Council |
Prime Cure Basic |
MDS0309 |
|
Liberty |
Silver Corporate Option |
MDS0345 |
|
Minemed |
Affordable |
MDS0342 |
|
Momentum Health |
Access Option |
MDS0322 |
|
Momentum Health |
Base Option |
MDS0322 |
|
NIMAS |
Primary Option |
MDS0346 |
|
Prosano |
Procedure |
MDS0324 |
|
Sizwe (New) |
Primary Option (New) |
MDS0351 |
|
Suremed |
Explorer |
MDS0347 |
|
SureOne |
Commair |
MDS0336 |
|
SureOne |
Dunn Stores |
MDS0336 |
|
Telemed |
Bronze |
MDS0343 |
|
Thebemed |
Universal Option |
MDS0328 |
|
Tlakano |
Basic Option |
MDS0339 |
|
Tlakano |
Comprehensive |
MDS0339 |
|
Tlakano |
LegalWise |
MDS0339 |
|
Tlakano |
MBD |
MDS0339 |
|
Tlakano (New) |
MBP - Med (New) |
MDS0339
|
|
Tlakano (New) |
MDB - Health (New) |
MDS0339 |
|
Tlakano |
St Davids |
MDS0339 |
|
Topmed |
Network Plan |
MDS0316 |
|
Transmed |
State + Network |
MDS0317 |
|
Transmed |
Ubuntu |
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 |
Vendors are cordially
requested to load the Prime Cure Contracted Medical Scheme Options under the specific
Medical Scheme.
E.g. BESTmed options:
- Blueprint
-
Bonus Plus
-
Millennium
Basic Current options
-
Millennium
Comprehensive
- Millenium Standard
-
Topcare
-
Vital Care
The Prime Cure Scheme
Option is à - Blueprint
Should the patient not know on which benefit/plan option
he/she is, then the Prime Cure “All scheme”
claiming code (MDS0300) can be used.
PLEASE NOTE THAT THE FOLLOWING PRIME CURE SCHEME OPTIONS HAVE BEEN DISCONTINUED FOR 2009.
|
MEDICAL
SCHEME |
PRIME
CURE OPTION |
SCHEME
CODE |
|
Protea |
Essential Network |
MDS0337 |
|
Protea |
Student Network |
MDS0337 |
|
PUREHealth |
Ozone |
MDS0340 |
PLEASE NOTE THAT THE FOLLOWING ARE NEW PRIME CURE SCHEME OPTIONS FOR 2009.
|
MEDICAL
SCHEME |
PRIME
CURE OPTION |
SCHEME
CODE |
|
Gen-Health |
Primary Cover |
MDS0350 |
|
Sizwe |
Primary Option |
MDS0351 |
|
Tlakano |
MBP - Med |
MDS0339 |
|
Tlakano |
MDB - Health |
MDS0339 |
PLEASE
NOTE: Medicine claims for members of the BERYL and
SAPPHIRE options of the Government Employee Medical Scheme (GEMS)
can only be submitted to QUALSA as from 1 January 2009. Please DO NOT send these claims to
Mediscor as they will be REJECTED.
If you require any assistance, please contact:
|
Mediscor’s Share Call Centre Helpline |
: |
086 011 3238 or 086 011 7705 |
Kind regards.
JACK PEREL