|
|
MEDISCOR
(PTY) LTD |
NOTIFICATION 7OF2011 |
21 April
2011
|
|
Medical Insurance Fund |
CIGNA SVS & InterGlobal
(MSO International) |
|
Administrator |
Medical Services Organisation (MSO) |
|
Information Relevant to |
New Mediscor Medical Insurance Funds |
|
Effective Date |
1 May 2011 |
With effect 1 May
2011, Mediscor will be applying the medicine claim rules
for two MSO International medical insurance funds, as outlined below.
Herewith the detail for submitting
medicine claims to Mediscor:
|
1. |
Scheme Code (PCN) |
MDS0069 |
|
2. |
Switch Destination Code |
MINT0001 |
|
3. |
Reference pricing (MRP®) |
Yes |
|
4. |
Maximum supply of
medicine |
30 Days |
|
5. |
Days of supply of the dispensed
medication |
Yes /Compulsory |
|
6. |
Membership number as per
membership card |
Yes / Compulsory |
|
7. |
Dependant code as per
membership card |
Yes / Compulsory |
|
8. |
Dependant first name as
per the membership card |
Yes / Compulsory |
|
9. |
Dependant date of birth |
Yes /Compulsory |
|
10. |
Dependant’s gender
(male/female) |
Yes / Compulsory |
|
11. |
Practice number of the
prescriber |
Yes / Compulsory |
|
12. |
ICD-10 diagnostic code |
Yes / Compulsory |
|
13. |
9 digit NAPPI code of
medicine dispensed |
Yes / Compulsory |
|
14. |
Membership number
requirements |
Minimum 6 numerical excluding
dependant code |
|
15. |
Payments to Providers |
MSO International |
|
16. |
Reimbursement structure –
Pharmacies |
SEP + 4 TIER |
|
17. |
Scheduled 0 or
Unscheduled |
SEP + max mark-up of 31%
(VAT Excl.) |
·
MEDISCOR REFERENCE PRICE (MRP®) – information available on www.mediscor.net
·
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 and Exclusion criteria;
SERVICE PROVIDERS MUST refer to our on-line responses to apply
the correct rules.
Herewith the medicine rules for MSO International
effective from 1 May 2011:
|
FUND |
BENEFITS APPLICABLE |
LEVY |
MRP® |
EXCLUSIONS |
|
CIGNA
SVS |
All benefits |
No levies applicable |
Yes |
N/A |
|
InterGlobal |
All benefits |
10% levy |
Yes |
1, 2, 58, 3, 4, 5, 7, 8, 9, 21,
20, 22, 23, 25, 27, 30, 19, 33, 34, 36, 24, 40, 50, 51, 32, 31, 37, 43, 44,
10, 61, 35, 38, 52, 53, 56, 60, 64, 26, 45, 57, 59 |
If you require any assistance, please contact:
|
Mediscor’s Share Call
Centre Helpline |
:
0860 113 238 or 0860 117 705 |
|
MSO
International (CIGNA SVS) |
:
011-259 5101 |
|
MSO
International (InterGlobal) |
:
011-259 5053 |
Kind regards.
JACK PEREL