Prime Cure Consultation Fee

PRIMECURE CONSULTATION FEE

Date: 21 Apr 2017

 

Our latest Medinol update does indeed cater for the code:

0181A – Being an all-inclusive Consultation plus Medicine tariff.

 

Please contact our Medinol Office to obtain the software update:

info@medinol.co.za

 

 

 

Medinol. Pedigreed Practice Management Software for Medical Billing and Claims.

 

MEDINOL MEDICAL BILLING | PRACTICE MANAGEMENT SOFTWARE

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, controls your outstanding debtors, 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.

Contact:

Fudley Bezuidenhout Pr.Eng.
Founder and CEO
Email: info@medinol.co.za
Ph: 021-906-2296
Cell: 082-688-9610

GEMS Emerald Value Option 2017

GEMS EMERALD VALUE OPTION 2017

 

Dear Healthcare Provider

 

GEMS new Emerald Value Option for 2017

 

The South African healthcare industry is undergoing many significant changes and developments towards

Universal coverage and other regulatory changes. Within this changing environment, GEMS is well equipped

to continue to deliver services that provide our members’ with significant value.

In an effort to further increase value and improve the quality of care and service convenience GEMS is

pleased to announce their new GEMS Emerald Value option which comes in to effect from 01 January 2017

(subject to approval by the Council for Medical Schemes).

This option is an affordable alternate to the current Emerald plan with a similar benefit structure which

offers the member value at a more affordable premium. The GEMS Emerald Value option pivots on a network

driven plan and includes a list of network hospitals where cover is provided in full subject to member benefits and scheme rules.

 

 

Care coordination is therefore key to the success of the GEMS Emerald Value option and when in need of treatment and/or possible referral to a Specialist, the member will be required to

* visit their nominated network Family Practitioner (FP), and if required,

* obtain a referral to a network Specialist

 

Should a member not adhere to the referral process and hospital network requirement with the exception of emergencies, co-payments will apply as follows,

* 30% copayment on the FP and Specialist account.

* Up to R10 000 hospital co-payment when not admitted to a network hospital

 

 

Dental and Optical visits on this option will also be subject to Network Providers.

A list of network Hospitals & Providers can be found on the GEMS website; www.gems.gov.za , members may also contact GEMS on; Enquiries@gems.gov.za or 0860 00 4367 or GEMS, Private Bag X782, Cape Town, 8000.

 

 

Kind regards

GEMS Network Management

29 December 2016

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A new option, called the “GEMS Emerald Value Option”, is to be introduced by GEMS in 2017. This option, will allow members who are on the Emerald option to opt for the “Value Option” of which the benefit will be a zero increase in contributions for 2017 in exchange for the following limitations:
• Every family member covered by GEMS to choose a family practitioner, with the allowance of consulting another GP when far from the chosen family practitioner, e.g. holiday
• Referral to a Specialist (excluding emergencies) only through the family practitioner
• Only utilisation of hospitals on a GEMS hospital network (excluding emergencies)

******************************

The new GEMS Emerald Value option, which includes a hospital network, offers the same rich benefits as the existing Emerald option, but at a more affordable rate.

Important things about the GEMS Emerald Value option

  • You must nominate a General Practitioner, who must be on the GEMS Network, as your first-line when seeking medical care and who you will consult for all your doctor visits. A 30% co-payment will apply to all GP claims received from a non-nominated GP.
  • You must use a hospital, of your choice, from the GEMS Emerald Value Hospital Network for your in-hospital needs. View the GEMS Emerald Value Hospital Network list for the list hospitals.
  • Specialist referral must be obtained from your nominated GP for all specialist requirements.
  • Provision is made in the event that you may require healthcare while travelling, or require specialised care that may not be available through your nominated healthcare providers, to ensure that your needs are taken care of. As part of this, you are allocated three visits to a non-nominated GP per family per year for emergencies only, i.e. in cases where you cannot get to your nominated GP.

Did you know?

Members who stay on Emerald face contribution increases of 15% for 2017, while members who switch from Emerald to the new GEMS Emerald Value will have lower increases – as low as 0%* – after their medical subsidy is included. *Please note: Depending on the number of dependents, most Emerald members will experience a 0% increase and even a decrease in the actual out-of-pocket amount they pay. Please consult your HR on what your subsidy entitlements are.

******************************

MEDINOL MEDICAL BILLING | PRACTICE MANAGEMENT SOFTWARE

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, controls your outstanding debtors, 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.

Contact:

Fudley Bezuidenhout Pr.Eng.
Founder and CEO
Email: info@medinol.co.za
Ph: 021-906-2296
Cell: 082-688-9610

Glencore Medical Scheme to be administered by Discovery Health

Dear Trading Partner/PMAs

 

Glencore Medical Scheme to be administered by Discovery Health

We can confirm that from 1 July 2016, Glencore Medical scheme will take on Discovery Health Medical scheme tariff guide, except the below will have different rates,

Dialysis and Pathology Networks

Hospital networks

GP Consult

Table:

0190 New and established patient: Consult R349

0191 New and established patient: Consult R349

0192 New and established patient: Consult R349

If you need more information, please e-mail electronic@discovery.co.za

Yours in good health ETM Team Discovery Health

 

Brought to you by Medinol Medical Billing Software South Africa

Polmed Membership Number

Who is Polmed

South African Police Service Medical Scheme (POLMED), is a closed medical scheme registered under the Medical Schemes Act (Act 131 of 1998). Only employees of the South African Police Service (SAPS), appointed under the South African Police Service Act (Act 68 of 1995), and their dependants are eligible to be members of POLMED.

The Board of Trustees is entrusted with ensuring the optimal operation of the Scheme to the benefit of the members. The Board of Trustees comprises of seven individuals that are elected and seven that are appointed by the National Commissioner.

The Trustees of the South African Police Service Medical Scheme (POLMED) recently awarded both its administration and managed care contracts to Medscheme (Pty) Limited.

Medscheme is a subsidiary of AfroCentric Health Limited, a wholly black-owned and controlled company – AfroCentric Investment Corporation Limited (AfroCentric). POLMED provides medical benefits to employees of the South African Police Services (SAPS) and is the fourth largest medical scheme in South Africa covering some 500 000 beneficiaries.

The Principal Officer, supported by Scheme Management, is responsible for executing the directives of the Board and ensuring that POLMED offers its members an excellent service.

South African Police Service Medical Scheme, also known as POLMED, is a medical aid scheme registered under the Medical Schemes Act (Act 131 of 1998).

Polmed provides a wide range of gap cover products to complement and enhance existing medical aid plans. POLMED offer cost effective products, assists with medical requirements and eliminates in-hospital short-falls.

Only employees of the SAPS appointed under the South African Police Service Act (Act 68 of 1995) and their dependents are eligible to be POLMED members.

The POLMED structure has become a beacon of hope to those who, because of their commitment to fight crime, often experience stressful conditions. POLMED, not limited to being a health programme scheme, also plays an active role in helping the government, contributing to the fight against corruption, within SAPS or outside.

POLMED works closely with SAPS Commercial Crime unit to report SAPS employees who abuse the system and ensure those who abuse their medical professions are investigated.

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Polmed Membership Number

Dear Service Provider
Kindly ensure that all Polmed claims are submitted with a nine digit membership number as displayed on their existing membership cards. This may require the insertion of leading zeros to a maximum length of 9 digits.
Medscheme has issued all Polmed members with new membership cards but will continue to support the use of the existing membership numbers as issued by the previous Medical Aid administrator.
Any claim submitted with an invalid number or one that does not have the leading zeros will be considered to be invalid and hence rejected upfront with the message Membership number not provided/invalid

2016 Polmed GP Tariffs

The GP tariffs will increase by 6% for both Network & Non-Network doctors for consultation codes namely 0190,0191 and 0192 which is R355.00 and R328 respectively.

All GP procedure codes will increase by 6% for all doctors.

CAMAF, Profmed, Keyhealth benefit changes 2016

CAMAF

 

IMMUNISATION BENEFITS FOR 2016

 

SCHEME/PLAN

IMMUNISATION MAX

ALLIANCE

R4100.00 per beneficiary per annum.

DOUBLE PLUS

R2040.00 per Adult per annum (22 years and older)

R3400.00 per Child per annum (0 – 21 years)

VITAL

R1360.00 per beneficiary per annum.

ESSENTIAL PLUS

R1360.00 per beneficiary per annum.

FIRST CHOICE

R1360.00 per beneficiary per annum.

NETWORK CHOICE

R1360.00 per beneficiary per annum.

 

PROFMED

 

PROACTIVE AND PROACTIVE PLUS MEMBERS DAY TO DAY BENEFIT CHANGE

The Day to Day cover of R500.00 per beneficiary, maximum R1500.00 per family, previously available for ProActive and ProActive Plus members in 2015 will be discontinued in 2016.

 

KEYHEALTH

 

MALARIA MEDICATION HEALTH BOOSTER BENEFIT

Malaria Medication Health Booster benefit will be implemented across all KeyHealth Health Booster Options effective 2016 and will cover 1 treatment per beneficiary per annum to the value of R300.00.