Mamoth Health Medical Scheme

Mamoth Health Medical Scheme

Date: 27 Jan 2012

 

NEW MAMOTH HEALTH SCHEME INFORMATION

Mamoth Health, a self administered scheme, will be processing medicine claims via MediKredit with effect from 1 February

2012. New acute and chronic option codes as indicated in the summary table have been assigned for the processing of all

plans.

2. HEALTHNET

2.1 Claims:

a) Claims should be submitted via HealthNet

2.2 Validation:

HealthNet will validate:

a) Membership number

b) Date of birth

c) Dependent Code

2.3 Networks:

HealthNet will accommodate all networks as agreed to with the scheme.

 

 

2.4 Markup & Dispensing Fee

a) Schedule 0 and nonscheduled items calculated on published wholesale price : R0 to R78.00: 34.20 %, Max R26.68 (Incl.

VAT)

b) Schedule 1 to 7 calculated on Single Exit Price: R0 to R78.00: 34.20 %, Max R26.68 (Incl. VAT)

2.5 Membership Number

a) Total length: 9 digits

2.6 Stale Claim Period

120 Days

2.7 Online Reversal Period

120 Days

3. PAYMENT INFORMATION

MediKredit will be paying providers on behalf of the scheme.

SUMMARY OF SCHEME RULES

PLAN/OPTION OPTION CODE SURCHARGE

MMAP/REF

PRICING or URP

MAMOTH HEALTH DD ACUTE MAHDA 612661 * Check HealthNet ST Response No

MAMOTH HEALTH DD CHRONIC MAHDC 612688 * Check HealthNet ST Response No

The Fam& Authcheck functionality will be available on these options.

.

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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

Metropolitan Health MHG Administered Medical Schemes

Afrox
Alliance Midmed
Anglo Medical Scheme
Bankmed
BP
Engen
Fishmed
GEMS
IMPERIALMED
MEDiPOS
Metropolitan
Nampak SA Medical Scheme
Netcare Medical Scheme
NIMAS
PG Group Medical Scheme
Pick n Pay
POLMED
Sappi
South African Breweries Medical Aid Scheme
TopMed
Transmed
Wooltru

Brought to you by Medinol Practice Management Software

TFG Medical Aid Scheme administered by Discovery Health

TFG Medical Aid Scheme to be administered by Discovery Health (Pty) Ltd from 1 January 2012

 

Discovery Health (Pty) Ltd administers 13 medical schemes at the moment. We’re pleased to let you know that from 1 January 2012, Discovery Health will also be administering TFG Medical Aid Scheme.

 

To ensure that healthcare providers and members of TFG Medical Aid Scheme experience a seamless transition in claiming under the new administrator, we include information about where you need to send claims for the members of TFG Medical Aid Scheme from 1 January 2012.

 

To identify themselves as valid members, members will carry membership cards issued by Discovery Health, branded with TFG Medical Aid Scheme logo. This is a typical example:

 

 

 

 

 

 

 

 

 

 

 


Submitting claims to TFG Medical Aid Scheme

 

Claims with a service date up to 31 December 2011

 

You can send claims with a service date up to 31 December to Metropolitan Health Group (MHG) as you have always done. You will have four months to send claims with a service date until the end of December 2011 to the Scheme. Any claims received after this will not be paid.

 

Claims with a service date from 1 January 2012

 

Please send claims for members of TFG Medical Aid Scheme to Discovery Health from 1 January 2012. You will need to use the member’s new membership number, which is printed on the newly issued membership cards.

 

 

Planned hospital admissions

 

Discovery Health will transfer all approved hospital admissions of members for 2012 to its administration database.

 

 

Reimbursement of claims for members of TFG Medical Aid Scheme

 

The Scheme will reimburse all GP’s in the GP network at the network rate, although TFGMAS benefits will apply.  TFGMAS has also adopted the Premier Rate Payment Arrangement for 2012.  TFG Medical Aid Scheme has also adopted the Discovery Health Rate as their rate of reimbursement of all claims with certain exceptions which will continue to be covered at the specific TFGMAS tariff.

Medical Aid Telephone Numbers

MEDICAL AID CONTACT TELEPHONE NUMBERS

Courtesy of Medinol Practice Management Software

 

AFRISAM SA MEDICAL SCHEME 011-767-7242
AFROX MEDICAL AID SOCIETY 0800-003-749
ALLCARE 011-290-6200

ALLIANCE MIDMED MED SCHEME 086-000-2101
ALTRON MEDICAL AID SCHEME 011-290-6200
ANGLOAMERICAN 0860-222-633
ANGLOVAAL 0860-100-456
AUTOMED 021-948-6400

BANKMED 0800-226-5633
BARLOWORLD MEDICAL SCHEME 086-111-2666
BENMED 011-293-1600

BESTMED MEDICAL SCHEME 086-000-2378
BMW EMPLOYEES MEDICAL AID SOCIETY 086-000-2107

BONITAS MEDICAL FUND 0860-002-147
BP MEDICAL AID SOCIETY 021-480-4610
BUILDING & CONSTRUCTION INDUSTRY MEDICAL FUND 011-208-1000
BUILDINGMED 021-950-7400

BUILT ENVIRONMENT PROFESSIONAL ASSOC (BEPMED) 031-5734000

Medical-Aid-Claims_software

CAPE MEDICAL PLAN 086-010-2930
CARECROSS 0860-101-159
CARLTON PAPER 021-423-2609

CHARTERED ACCOUNTANTS MEDICAL AID FUND (CAMAF) 086-170-0600
CLICKS GROUP MEDICAL SCHEME 021-4601202
COMMED 086-131-1911

COMMUNITY MEDICAL AID SCHEME (COMMED) 011-290-6338
COMPCARE WELLNESS MEDICAL SCHEME 011-2081000
DE BEERS BENEFIT SOCIETY 053-807-3111
DENIS 0860033647

DISCOVERY HEALTH MEDICAL SCHEME 0860-445-566
DRC 086-111-5057

EDCON MEDICAL AID SCHEME 011-495-6707
ENGEN MEDICAL BENEFIT FUND 080-000-1615
EYETHUMED MEDICAL SCHEME 0860-502-502
FEDHEALTH MEDICAL SCHEME 0860-104-555
FISHING INDUSTRY MEDICAL SCHEME (FISH-MED) 086-010-4121
FOOD WORKERS MEDICAL BENEFIT FUND 021-9303550
FOSCHINI GROUP MEDICAL AID SCHEME 021-480-5064
GEMS 086-000-4367

GEN-HEALTH MEDICAL SCHEME 011-457-8700
GENESIS MEDICAL SCHEME 0860-102-010
GOLD FIELDS MEDICAL SCHEME 041-395-4400
GOLDEN ARROWS EMPLOYEES MEDICAL BENEFIT FUND 0860-104-122
GOOD HOPE MEDICAL AID SOCIETY 011-208-1000
GOVERNMENT EMPLOYEES MEDICAL SCHEME (GEMS) 012-362-6321
GRINTEK ELECTRONICS MEDICAL AID SCHEME 011-208-1000
HOSMED MEDICAL AID SCHEME 0860-000-048
IBM (SA) MEDICAL SCHEME 086-010-0418
IMPALA MEDICAL PLAN 014-5697597
IMPERIAL GROUP MEDICAL SCHEME 086-046-7374
INGWE HEALTH PLAN 086-010-2493
KEYHEALTH 086-067-1050
KILOCARE 021-931-7356

LA-HEALTH MEDICAL SCHEME 021-555-4727
LAMAF 021-402-8840

LIBCARE MEDICAL SCHEME 080-012-2273
LIBERTY MEDICAL SCHEME 086-000-2163
LONMIN MEDICAL SCHEME 086-010-4883

dental-software

MALCOR MEDICAL SCHEME 011-372-1500
MASSMART HEALTH PLAN 086-000-2117
MBMED MEDICAL AID FUND 011-510-2000
MEDCOR 012-673-8733
MEDICOVER 086-000-2163

MEDIHELP 086-010-0678
MEDIMED MEDICAL SCHEME 041-395-4400
MEDIPOS MEDICAL SCHEME 086-010-0078
MEDSHIELD MEDICAL SCHEME 0860-002-147
MEDSCHEME 086-111-2666
METHEALTH021-480-4411

METROCARE 086-000-2123
METROPOLITAN MEDICAL SCHEME 086-188-8104
MIMED 011-329-8800

MINEMED MEDICAL SCHEME 041-395-4400
MOMENTUM HEALTH 086-011-7859
MOREMED MEDICAL SCHEME 086-010-1103
MOTO HEALTH CARE 086-132-9800 / 0861 000 300
MUNIMED 0860-671-1050
MX HEALTH 012-673-8985

NAMPAK (SA) MEDICAL SCHEME 086-010-1047
NASPERS MEDICAL FUND 0860-445-5666
NATIONAL INDEPENDENT MEDICAL AID SOCIETY (NIMAS) 0860-100-670
NBC MED 011-290-6200

NEDGROUP MEDICAL AID SCHEME 086-111-2666
NETCARE MEDICAL SCHEME 086-010-3406
NIMAS 0860-100-671
NMP (NATIONAL) 031-573-4000

medicalbillingsoftware

OLD MUTUAL STAFF MEDICAL AID FUND 0860-100-456
OMNI-HEALTH 0860-888-014
OPMED 012-427-5333
ONE CARE 011-234-3578

OXYGEN MEDICAL SCHEME 021-532-6800 or 0860 101 233
PARMED MEDICAL AID SCHEME 086-000-2126
PG BISON MEDICAL AID SOCIETY 086-010-9595
PG GROUP MEDICAL SCHEME 11-417-5800
PHAROS MEDICAL PLAN 031-267-5000
PICK N PAY MEDICAL SCHEME 080-000-4389
POLMED 086-076-5633

PLATINUM HEALTH 014-591-3069
PRIMECURE 086-166-5665
PROFMED 086-067-9200

PROSANO MEDICAL SCHEME 0860-002-035
PROFMED 011-628-8904
PROTEA MEDICAL AID SOCIETY 021-552-7111
PROTECTOR 012-421-2022
PROVIA 0860-102-472
PROVIDENCE 041-395-4545

PUREHEALTH MEDICAL SCHEME 086-010-9393
QUANTUM MEDICAL AID SOCIETY 086-010-2958
RAND WATER MEDICAL SCHEME 011-682-0560
REMEDI MEDICAL AID SCHEME 0860-102-472
RESOLUTION HEALTH MEDICAL SCHEME 0861-111-778
RETAIL MEDICAL SCHEME 021-980-4465
RHODES UNIVERSITY MEDICAL SCHEME 041-395-4476
S A BREWERIES MEDICAL AID SOCIETY 086-000-2133
SABC MEDICAL AID SCHEME 086-000-2136
SAMWUMED 086-010-4117
SAPPI MEDICAL AID SCHEME 086-010-1280
SASOLMED 086-000-2134
SEDMED 051-4478271
SELFMED MEDICAL SCHEME 086-010-5508
SIEMENS MEDICAL SCHEME 011-671-2000

SIZWE MEDICAL FUND 0860-100-871
S.A. POLICE SERVICE MEDICAL SCHEME (POLMED) 012-431-0239
SOVEREIGN HEALTH 031-367-6800

SPECTRAMED 0861-497-497
STATUS – UNIVERSAL 011-208-1000

STOCKSMED 086-000-2137
SUREMED HEALTH 086-008-0888
TELEMED 0860-119-553

THEBEMED 011-5448899
TIGER BRANDS MEDICAL SCHEME 011-2081000
TOPMED MEDICAL SCHEME 0860-002-158
TRANSMED MEDICAL FUND 080-011-0268
TRAWLMED 021-712-8775

TSOGO SUN GROUP MEDICAL SCHEME 086-010-0421
UMED 012-667-8008
UMVUZO HEALTH MEDICAL SCHEME 012-8450000
UNIVERSITY OF KWAZULU NATAL MEDICAL SCHEME 031-260-1007
UNIVERSITY OF WITWATERSRAND STAFF MEDICAL AID 086000-2140
WITBANK COALFIELDS MEDICAL AID SCHEME 013-6561407
WOOLTRU HEALTHCARE FUND 080-222-8922
XPRESS CARE 011-375-3000

XSTRATA MEDICAL AID SCHEME 086-000-2141
practice management software review

 

Click here for Medical Aid or Administrator Website(s).

 

For the best Practice Management Software 

 

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