Mamoth Health Medical Scheme
NEW 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 Mark‐up & Dispensing Fee
a) Schedule 0 and non‐scheduled 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 On‐line 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‐ & Auth‐ check functionality will be available on these options.
Related posts:
- TFG Medical Aid Scheme administered by Discovery Health
- Edcon Medical Aid amalgamating with Discovery Health Medical Scheme
