|
|
MEDISCOR
(PTY) LTD |
NOTIFICATION 7OF2009 |
26 May
2009
|
|
Medical Scheme |
Prime
Cure |
|
Administrator |
Prime Cure |
|
Information
Relevant to |
New Option on Prime Cure Thlakano Medical Scheme |
|
Effective Date |
1 June 2009 |
Please note the new option under Prime Cure Thlakano Medical
Scheme effective
1 June 2009:
·
MAHALA (MDS0339)
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 + 30% / R20.00
|
|
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
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 |
Primary Cover |
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 |
Corporate Network Option |
MDS0345 |
|
Minemed |
Affordable |
MDS0342 |
|
Momentum Health |
Access Option |
MDS0322 |
|
Momentum Health |
Base Option |
MDS0322 |
|
NIMAS |
Primary Option |
MDS0346 |
|
Prosano |
Procedure |
MDS0324 |
|
Sizwe |
Primary Network Option |
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 |
Essential Life |
MDS0339 |
|
Tlakano |
MBP - Med |
MDS0339
|
|
Tlakano |
MDB - Health |
MDS0339 |
|
Tlakano |
St Davids |
MDS0339 |
|
Tlakano |
Mahala (NEW) |
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.
If you require any assistance, please contact:
|
Mediscor’s
Share Call Centre Helpline |
: |
086 011 3238 or 086 011 7705 |
Kind regards.
JACK PEREL