2015 GEMS Dental Benefits

Dental Benefit Changes

 

Below is a summary of the dental tariffs and managed care protocols for 2015 that are included in the 2015 Dental Provider Guide.

 

Tariffs and Benefits for 2015:

Tariffs: A tariff increase of 6% on all dental procedures for contracted (Network) dental providers and 3.8% for non-contracted providers from 1 January 2015.

 

The following changes to the Sapphire/Beryl benefit options will become effective on 1 January 2015:

 

• Sutures (code 8220) – May be charged in association with surgical extractions and/or impactions. Quantity limited to once per year.

 

• Surgical removal of residual roots, first tooth (code 8213) – per tooth – A maximum of one procedure applies. More than one requires clinical motivation – One event per year applies. Benefit from 12 years.

• Surgical removal of residual roots, second and subsequent teeth’s roots (code 8214) – A maximum of one procedure applies. More than one requires clinical motivation – One event per year applies. Benefit from 12 years.

 

• Surgical removal of impacted tooth – first tooth (code 8941). May also be performed in the dental provider’s rooms. Note: Pre-authorisation needed if done in hospital.

• Surgical removal of impacted tooth – second tooth (code 8943). May also be performed in the dental provider’s rooms. Note: Pre-authorisation needed if done in hospital.

• Surgical removal of impacted tooth – third and subsequent teeth (code 8945). May also be performed in the dental provider’s rooms. Note: Pre-authorisation needed if done in hospital.

• Conditions associated with pain and sepsis i.e. extractions (code 8201/8202) and pulpotomy (on primary teeth only – code 8307) may include two events per year.

 

Both the 2015 tariff files as well as the Dental Provider manual will be placed on the GEMS website at

www.gems.gov.za for easy and convenient access by dental providers.

It is important to note that there will be a differentiation in the 2015 increase in favour of Network Providers as stipulated above.

 

 

 

 

 



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Medinol is one of the few purpose-built practice management application to meet the unique needs of independent private healthcare providers. Today Medinol helps over 130 providers throughout South Africa run more efficient and profitable practices, while delivering outstanding patient care. As an on-premise software, Medinol and the data it manages, is fully under your control. This enhances your independence and privacy: what happens in your rooms, stays in your rooms. Medinol helps manage your patient information, generates your billings, submits your claims, control your outstandings, and get your accounts paid quickly. Medinol has been in operation since 1984 demonstrating its proven efficacy. Medinol’s mission is to help independent practices succeed in an ever-changing healthcare environment. More information can be found at http://medinol.co.za.

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