2018 Medical Scheme Tariff Increase
2018 Medical Aid Increases for HealthCare Providers
For the following medical aids/schemes:
- Discovery Health
- Bankmed
- Glencore
- SABMAS
- AMS
- Netcare
Brought to you by Proven Medical Practice Management Software
Dental Practices
Dental Practices
Edcon Medical Scheme Update
Edcon Medical Scheme Update
Date: 24 Oct 2018
EDCON medical scheme will be merging with Discovery Health and claims should still be submitted on the existing Discovery Health option: DSGHL 604944.
Medinol – Medical Aid Claims 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 https://medinol.co.za.
Contact:
Fudley Bezuidenhout Pr.Eng.
Founder and CEO
Email: info@medinol.co.za
Ph: 021-906-2296
Cell: 082-688-9610
Bonitas / Liberty Medical Scheme Amalgamation from 1 October 2016
Bonitas/LMS amalgamation gets go-ahead
In the largest transaction of its kind in SA healthcare, the amalgamation of Bonitas withLMS has been approved, reports Fin24.
The amalgamation between Bonitas Medical Fund (Bonitas) and LMS Medical Scheme(previously known as Liberty Medical Scheme) has received the stamp of approval by theCompetition Commission and the Council of Medical Schemes (CMS) effective 1 October 2016.
According to a statement issued on behalf of Bonitas, it is the largest transaction of its kind in the SA healthcare industry.
Bonitas, administered by Medscheme, is South Africa’s second largest open medical aid with financial indicators above the legislated requirements and industry average. An open medical aid means there are no restrictions on membership based on employment or profession and it is, therefore, open to the general public.
In August, when the Competition Tribunal approved the amalgamation, it was done without conditions, Lerato Motaung, Competition Tribunal registrar said at the time. Motaung said the Commission had found some overlap of the merging parties’ activities in relation to the administration and managed care services, but the services are carried out contractually by third parties, not by the merging parties themselves. The Commission felt the merging parties would continue to face competition from other medical aid schemes.
The report say Dr Bobby Ramasia, principal executive officer of Bonitas has now confirmed receipt of the official notification by the CMS. “Initially our aim was to begin trading as one entity as from August, however, considering the impact of the amalgamation – not only on members but the industry as a whole – it was imperative that all the regulatory processes were followed. This marginally delayed the approval, as everything had to be carefully considered and weighed up by the Competition Commission and CMS,” said Ramasia.
“However, we are pleased it has now been ratified and is in the process of finalisation of all the legalities in order to begin trading. Official notification to members will be sent out shortly outlining the way forward but we’d like to reassure them that this amalgamation is in their best interests.”
The report says the amalgamation was explored after the positive outcome of an initial feasibility study. According to Bonitas, the amalgamated scheme will have a broader national footprint, better economies of scale to negotiate better rates and improve provider networks. The amalgamated scheme will be stronger and more sustainable, providing enhanced cover and benefits, consolidation of resources and fixed costs. This will assist with relieving pressure on future contribution increases.
“With our combined years of experience we have an intricate understanding of the needs of the consumer in the complex healthcare market,” explained Ramasia. “Our increased size in terms of members and national footprint will enhance our ability to negotiate better benefits and services with healthcare providers.”
Ramasia reassured members that throughout the amalgamation process, both schemes were committed to acting in the best interest of members at all times and this is set to continue. Liberty Health reported a loss of R11m for the six months to the end of June compared to R22m from the prior period. It was in talks with Spectramed on more than one occasion for a potential takeover.
Bonitas and Liberty said earlier this year that if the merger is successful, it will continue under Bonitas’ name, the report said.
NETCARE & PG GROUP Update
NETCARE & PG GROUP Update
Date: 23 Oct 2018
Dispensing as well as Procedure and Consultation claims for Netcare and PG Group, processing on the Metropolitan Health Group
platform effective 1 January 2012, should be submitted on the new option codes indicated in the table below:
Validations: Exact match checking against the Card Holder File will be done on the following patient/member details:
a) Membership Number
b) Date of Birth
c) Dependant Code
d) Patient First name (1st 3 characters)
Medinol Medical aid claims 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 https://medinol.co.za.
Contact:
Fudley Bezuidenhout Pr.Eng.
Founder and CEO
Email: info@medinol.co.za
Ph: 021-906-2296
Cell: 082-688-9610
Protea Medical Aid Society under provisional liquidation
Protea Medical Aid Society under provisional liquidation
Date: 19 April 2011
Press release 2 of 2011: Protea under provisional liquidation
Mr Velaphi Petsana was appointed curator of Protea Medical Aid Society on 29 October 2010 in terms of in order of the Western Cape High Court.
On 5 April 2011, the curatorship was cancelled and the medical scheme was placed under provisional liquidation in the hands of the Master of the Western Cape High Court, following reports from the curator.
The order of 5 April 2011 was published in the Cape Times on 7 April 2011 and Die Burger on 8 April 2011.
Interested persons have until 19 April 2011 to show cause to the court as to why the final order of liquidation should not be granted.
The Master of the Western Cape High Court has appointed Mr Ralph Farrell Lutchman of Concord Administrators (Pty) Ltd and Mr Raphael Brink of Brink & Thomas Attorneys as provisional liquidators of the scheme.
Mr Lutchman’s contact details are as follows:
E-mail: ralph@concordadmin.co.za
Tel: 012 362 6580
Cell: 084 5151 335
Concord Administrators (Pty) Ltd can also be contacted on 0861 874 926 or 012 333 6162.
The contact details of Brink & Thomas Attorneys are as follows:
Tel: 021 424 1564
Fax: 086 666 7799
Section 64(3) of the Medical Schemes Act 131 of 1998 provides that during liquidation the provisions of the Act continue to apply to the medical scheme as if the liquidator were the person managing the business of the medical scheme.
The provisional liquidators advise that:
* they are engaging service providers who have or are providing healthcare services to members of Protea;
* they are attending to the claims of the service providers; and
* all actions against the members of Protea must be kept in abeyance while the liquidation process unfolds.
“At the time when we applied for liquidation, the scheme’s solvency ratio was such that a single large claim could deplete its reserves entirely, leaving members exposed,” said Registrar of Medical Schemes Dr Monwabisi Gantsho today. “Where trustees fail to exercise their fiduciary duties, the regulator is forced to step in and take the necessary measures to protect the members of a struggling scheme.”
The latest audited figures show that, at the end of 2009, Protea had just over 7 000 beneficiaries and a solvency of 19.0%.
Brokers are again advised to act with restraint. Any advice they give must accord with the principles of best advice, have the best interests of their clients at heart, and be based on a proper assessment of the situation.
Medinol Practice Management Software users are advised not to accept Protea Medical Aid members for treatment on medical aid.
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 https://medinol.co.za.
Contact:
Fudley Bezuidenhout Pr.Eng.
Founder and CEO
Email: info@medinol.co.za
Ph: 021-906-2296
Cell: 082-688-9610
2015 Tariffs|Rates
2015 Tariffs – Medical and Dental
Don’t you just love this time of the year? NOT!!! The scrumaging around for the new year’s tariffs, the uncertainty, and the effort it takes to review and update tariffs and prices for fees to be used in 2015?
Medical Practitioners (GP’s)
The 2015 Tariffs encompasses consultations, procedures and special rates (insurance companies, etc). As per previous years, we choose the route of lowest common denominator. This is motivated by the overarching need to preserve year-end (slow month) cash flow, by avoiding medical aid rejections at all costs.
By way of example, what we do, in the case of say urine analysis, where different medical aids pay different rates, we choose to deploy the lowest rate/tariff to make sure we get paid by all medical schemes.
Medinol Medical Users:
Contact our offices on 021 906 2296 to get your 2015 Medical Tariffs Update.
Also, if dispensing is your thing, we have an update for these as well. Our Lazy Dispensing GP’s Genie will provide a comprehensive lookup of all medication showing SEP and dispensing (SELLING) price. Click here to get it.
Non-Medinol Medical Practitioners:
For reliable, easy and one of the most effective Medical Billing Software in South Africa, click here.
Dental Practitioners (Dentists)
The 2015 Tariffs encompasses consultations, procedures and laboratory fees. As in previous years, the size of this file is in the region of 880 records. Depending on your respective patient volumes, you can elect to choose either the 2015 Discovery Rates, DENIS Rates or GEMS Rates.
Danger with 2015 Discovery rates: if you are contracted in and you charge one cent more than the published tariffs, payment will be made to the member, not you. If you persist in this behavior (without correcting), your practice will be deemed as non-compliant and yours will be flagged internally by Discovery as being eligible for non-direct payment. This means all payments will be made to the member, not you.
MEDINOL Practice Management Software-ONLY Dental Users:
1. Click here to get your 2015 Discovery-Based Dental Tariffs Update
2. Click here to get your 2015 GEMS/MHG-Based Dental Tariffs Update.
3. Click here to get your 2015 DENIS Dental Tariffs Update.
Otherwise, Non-Medinol Dental Practitioners:
For the best Dental Practice Management Software in South Africa, click here.