|
|
MEDISCOR (PTY) LTD |
NOTIFICATION 64
OF
2008 |
18 December 2008
|
|
Medical
Scheme |
Medicross |
|
Administrator |
Medicross |
|
Information
Relevant to |
Medicross Capitation and Benefits for 2009 |
|
Effective
Date |
1 January 2009 |
With effect 1 January 2009, Mediscor will be
applying the scheme rules for Medicross scheme options as outlined
below.
·
The Medicross Formulary will be applied.
Herewith the details for
submitting medicine claims to Mediscor:
|
1. |
Scheme Code (PCN) |
1. |
As per list below / MDM0000 |
|
2. |
Switch Destination Code |
2. |
MCAP0001
|
|
3. |
MRP® |
3. |
Yes |
|
4. |
Maximum supply of medicine |
4. |
30 Days |
|
5. |
Days of supply of the dispensed
medication |
5. |
Yes /Compulsory |
|
6. |
Membership number as per
membership card |
6. |
Yes / Compulsory |
|
7. |
Dependant code as per membership
card |
7. |
Yes / Compulsory |
|
8. |
Dependant first name as per the
membership card |
8. |
Yes / Compulsory |
|
9. |
Dependant date of birth |
9. |
Yes /Compulsory |
|
10. |
Dependant’s gender (male/female) |
10. |
Yes / Compulsory |
|
11. |
Practice number of the prescriber |
11. |
Yes / Compulsory |
|
12. |
ICD-10 diagnostic code |
12. |
Yes / Compulsory |
|
13. |
9 digit NAPPI code of medicine
dispensed |
13. |
Yes / Compulsory |
|
14. |
Payments to Providers |
14. |
Medicross |
|
15. |
Chronic/PMB pre-authorisation at
Mediscor |
15. |
Yes – Mediscor ChroniLine™ |
|
16. |
Reimbursement structure -
Pharmacies |
16. |
SEP + 26% / R26.00 |
|
17. |
Reimbursement structure – Schedule 0 or Unscheduled
Medicine |
17. |
SEP + max mark-up of 31% (Excl. VAT) |
|
18. |
OTC |
18. |
Yes – Selected Options |
·
MEDISCOR REFERENCE PRICE
(MRP®) – information available on www.mediscor.net
·
MEDICROSS CHRONIC/PMB
FORMULARY – information available on www.mediscor.net
·
MEDICROSS ACUTE FORMULARY
– information available on www.primecure.co.za or www.mediscor.net
·
ICD-10 CODES – information available on www.medicalschemes.com
Herewith a
summary of Medical Scheme Options Contracted to Medicross:
MEDICAL
SCHEME OPTIONS CONTRACTED TO MEDICROSS:
|
MEDICAL
SCHEME |
MEDICROSS
OPTION |
SCHEME
CODE |
|
CAMAF |
Network Choice |
MDM0030 |
|
Ingwe |
Medicap Option |
MDM0003 |
|
Momentum Health |
Access Option |
MDM0021 |
|
PUREhealth |
Purenetwork |
MDM0031
|
|
Telemed |
Gold Select |
MDM0032 |
Medicross All Scheme
|
Medicross All Scheme
|
MDM0000
|
Vendors are cordially
requested to load the Medicross Contracted Medical Scheme Options under the
specific Medical Scheme.
E.g. PUREhealth options:
- Famplus Option
-
Savemed
Option Current Options
-
Topcare
Option
The Medicross Scheme
Option is à
- Purenetwork Option
Should the patient not know on which benefit/plan option
he/she is, then the Medicross “All scheme”
claiming code (MDM0000) can be
used.
PLEASE NOTE THAT THE FOLLOWING SCHEME OPTIONS HAVE BEEN DISCONTINUED
FOR 2009:
|
MEDICAL SCHEME |
MEDICROSS OPTION |
SCHEME CODE |
|
Day 1
Health |
Platinum
Plan |
MDM0023 |
If you require any assistance, please contact:
|
Mediscor’s Share Centre Helpline |
: |
086 011 3238 or 086 011 7705 |
Kind regards
JACK PEREL