2016 GEMS GP Tariffs (RUBY EMERALD ONYX)

As per communique from GEMS (RUBY EMERALD ONYX) 2016 Tariffs 3. Tariff changes for 2016 Please be advised of the following changes for 2016: An increase of 5.5% in professional fees for doctors participating in the GEMS FP network. The following fees will be applicable to REO network doctors in 2016: GEMS REO FP network consultation fee (Scheme rate) R326.70 …

Government Employees Medical Scheme (GEMS) faces insolvency threat

The Government Employees Medical Scheme (GEMS) could be insolvent by financial year-end if drastic cost-containment measures are not instituted, reports Business Day. This would mean the scheme would need to be bailed out by the Treasury or amalgamated into a different scheme, forcing significant changes in benefits for its 1.8m members. The report said it would be a big blow to those in government who …

GEMS Bemoans Inappropriate ICD-10 Z-Code Usage

Dear Doctor THE INAPPROPRIATE USE OF Z-CODES IN CLAIMS SUBMITTED TO THE SCHEME It is almost a year since GEMS’ communication to healthcare practitioners encouraging the use of specific ICD-10 Codes on claims submitted to the Scheme. The recent GEMS audit done on claims received to date indicates the continued use of Z-Codes on a number of claims that have …

2015 GEMS REO Billing Changes

2015 GEMS Billing FP Change: Scheme Rate Whereas in the past, claims were submitted REPI1, REPI2 and REPI3, GEMS REO have now requested that consultations (0190) be submitted at the “FP Network Consultation Fee”. Medscheme themselves will add the enhanced fee. GEMS, themselves, will add the enhanced consultation fee. ************************** E.g. Practice submits GEMS REO claim 0190 at R309.70 For a Category 1 …

GEMS EDI Destination Codes

  Correct Switching codes for Government Employees Med Scheme(GEMS)   875   GEMS0001 (GEMS EMERALD OPTION) Metropolitan Health Group 925   GEOP0001 (GEMS ONYX, SAPPHIRE & BERYL OPTION) Metropolitan Health Group 926   GROP0001 (GEMS RUBY OPTION) Metropolitan Health Group