Medical Aid
Medinol Users: Please omit the trailing “P”, e.g. use 027 and NOT 027P.
| Scheme Name | Scheme Administrator | QEDI Code |
| AECI MEDICAL AID SOCIETY | Medscheme | 027P |
| AECI MEDICAL AID SOCIETY VALUE OPTION | Universal Healthcare Administrators (Pty) Ltd. | 215P |
| AFA BROADREACH | Medscheme | 290P |
| AFA CORPORATE | Medscheme | 304P |
| AFFINITY HEALTH | Pan African Managed Care (Pty) Ltd | 276P |
| AFROX MEDICAL AID SOCIETY | Metropolitan Health Group | 248P |
| ALLIANCE MIDMED MEDICAL SCHEME | Private Health Administrators (Pty) Ltd | 224P |
| ALTRON MEDICAL AID SCHEME | Discovery Health Administrators | 033P |
| ANGLO MEDICAL SCHEME | Momentum Metropolitan Investments (MMI) | 037P |
| ANGLOVAAL GROUP MEDICAL SCHEME | Discovery Health Administrators | 036P |
| BANKMED MEDICAL SCHEME | Metropolitan Health Group | 042P |
| BARLOWORLD MEDICAL SCHEME | Medscheme | 043P |
| BCIMA (BUILDING AND CONSTRUCTION INDUSTRY | Universal Healthcare Administrators (Pty) Ltd. | 733P |
| MEDICAL AID FUND) | ||
| BESTMED MEDICAL SCHEME | Bestmed | 045P |
| BMW EMPLOYEES MEDICAL AID SOCIETY | Medscheme | 048P |
| BOMAID | BOMaid Medical Aid | 595P |
| BONITAS MEDICAL FUND | Medscheme | 050P |
| BOTSWANA PUBLIC OFFICES | A.F.A. Administrators | 594P |
| BP SOUTHERN AFRICA MEDICAL AID SOCIETY | Metropolitan Health Group | 056P |
| BUILDING INDUSTRIES P.E. | Industrial Council P.E. | 593P |
| CAMAF | Eternity Private Health Fund Administrator (Pty) | 079P |
| CAPE MEDICAL PLAN | Cape Medical Plan | 052P |
| CARECROSS | Carecross | 561P |
| CENTRE FOR DIABETES AND ENDOCRINOLOGY (CDE) | Centre For Diabetes And Endocrinology (CDE) | 389P |
| CHARIOT FINANCIAL SERVICES MEDICAL FUND | Chariot Financial Services Medical Fund | 596P |
| COMMED FUNDAMENTAL OPTION | Enablemed | 230P |
| COMMUNITY MEDICAL AID SCHEME (COMMED) | Allcare Administrators (Pty) Ltd | 009P |
| COMPCARE MEDICAL SCHEME | Universal Healthcare Administrators (Pty) Ltd. | 129P |
| COMPENSATION FUND (IOD) | Compensation Fund (IOD) | 454P |
| COMPSOL (IOD CLAIMS) | IOD Claims: Compsol | 704P |
| DE BEERS BENEFIT SOCIETY | De Beers Benefit Society | 066P |
| DENTAL RISK COMPANY | DRC Dental Risk Company | 406P |
| DISCOVERY HEALTH MEDICAL SCHEME | Discovery Health Administrators | 125P |
| DOMESTICARE | Carecross | 226P |
| EMERGING MARKET HEALTHCARE | Emerging Market Healthcare | 289P |
| ENGEN MEDICAL BENEFIT FUND | Metropolitan Health Group | 269P |
| ESSENTIAL MED | 1 Doctor Health | 460P |
| EYETHUMED MEDICAL SCHEME | Medscheme | 782P |
| FARANANI HEALTH SOLUTIONS | Faranani Health Solutions | 859P |
| FEDHEALTH MEDICAL SCHEME | Medscheme | 160P |
| FISHING INDUSTRY MEDICAL SCHEME (FISHMED) | Metropolitan Health Group | 779P |
| FOSCHINI GROUP MEDICAL SCHEME | Discovery Health Administrators | 083P |
| FURNMED | Eminent Wealth Consult Pty Ltd | 470P |
| GENESIS MEDICAL SCHEME | Definiti Medical Fund Managers | 518P |
| GETMED | GETMED | 349P |
| GETMED AFRICA (SWAZILAND) | GETMED Swaziland | 381P |
| GETMED STUDENT 500 | Enablemed | 415P |
| GOLD FIELDS MEDICAL SCHEME | Providence Health Risk Managers | 116P |
| GOLDEN ARROW EMPLOYEES MEDICAL BENEFIT FUND | Metropolitan Health Group | 363P |
| GOVERNMENT EMPLOYEES MEDICAL SCHEME (GEMS | Metropolitan Health Group | 875P |
| EMERALD OPTION) | ||
| GOVERNMENT EMPLOYEES MEDICAL SCHEME (GEMS ONYX | Metropolitan Health Group | 925P |
| OPTION) | ||
| GOVERNMENT EMPLOYEES MEDICAL SCHEME (GEMS RUBY | Metropolitan Health Group | 926P |
| OPTION) | ||
| GRINTEK ELECTRONICS MEDICAL AID SCHEME | Universal Healthcare Administrators (Pty) Ltd. | 259P |
| GROOMS COVER OPTION | Enablemed | 173P |
| HAIRDRESSING SICK BENEFIT FUND CAPE TOWN | Hairdressing Sick Benefit Fund | 597P |
| HARMONY HEALTH SERVICES | Providence Health Risk Managers | 870P |
| HEALTH4ME | Momentum Metropolitan Investments (MMI) | 472P |
| HORIZON MEDICAL SCHEME | Medscheme | 444P |
| HOSMED MEDICAL AID SCHEME | Thebe YaBophelo Healthcare | 523P |
| IBM SA MEDICAL AID SOCIETY | Discovery Health Administrators | 943P |
| IMPALA MEDICAL PLAN | Providence Health Risk Managers | 439P |
| IMPERIAL GROUP MEDICAL SCHEME | Metropolitan Health Group | 364P |
| KEYHEALTH | PPS Medical Scheme Administrators | 510P |
| LA HEALTH | Discovery Health Administrators | 525P |
| LIBCARE MEDICAL SCHEME | V Medical Aid Administrators | 099P |
| LIBERTY BLUE MEDICAL SCHEME | V Medical Aid Administrators | 008P |
| LIBERTY HEALTH MEDICAL SCHEME | V Medical Aid Administrators | 101P |
| LONMIN MEDICAL SCHEME | Discovery Health Administrators | 945P |
| MAKOTI COMPREHENSIVE AND PRIMARY | Enablemed | 302P |
| MALCOR MEDICAL SCHEME | Eternity Private Health Fund Administrator (Pty) | 104P |
| MALCOR OPTION D | Enablemed | 255P |
| MAMOTH HEALTH PLAN | Mamoth Employee Benefits (Pty) Ltd | 247P |
| MASCA ZIMBABWE | MASCA Zimbabwe | 598P |
| MASSMART HEALTH PLAN | Medscheme | 038P |
| MB MED | Medscheme | 180P |
| MEDIHELP | Medihelp | 256P |
| MEDIMED MEDICAL SCHEME | Providence Health Risk Managers | 265P |
| MEDIONE SICK FUND | Oneplan Medical Insurance | 168P |
| MEDIPOS MEDICAL SCHEME | Metropolitan Health Group | 250P |
| MEDSHIELD MEDICAL SCHEME | Medshield Administrators | 111P |
| METROPOLITAN MEDICAL SCHEME | Metropolitan Health Group | 121P |
| MINEMED MEDICAL SCHEME | Providence Health Risk Managers | 378P |
| MMED OPTION OF THE NASPERS MEDICAL FUND | Discovery Health Administrators | 362P |
| MOMENTUM HEALTH AFRICA | Momentum: HDS Medical Management | 237P |
| MOMENTUM HEALTH MEDICAL SCHEME | Momentum Metropolitan Investments (MMI) | 822P |
| MOTO HEALTHCARE | Momentum Metropolitan Investments (MMI) | 940P |
| MSO INTERNATIONAL | MSO | 292P |
| NAMIBIA HEALTH PLAN | Medscheme Namibia | 206P |
| NAMIBIA IND MEDICAL AID | Medscheme Namibia | 600P |
| NASPERS MEDICAL FUND | Discovery Health Administrators | 512P |
| NBCRFLI WELLNESS FUND HEALTH PLAN | Universal Healthcare Administrators (Pty) Ltd. | 010P |
| NEDGROUP MEDICAL AID SCHEME | Medscheme | 016P |
| NETCARE MEDICAL SCHEME | PrimeMed | 067P |
| NUFSWSA SICK BENEFIT SOCIETY | Eminent Wealth Consult Pty Ltd | 624P |
| OLD MUTUAL STAFF MEDICAL AID SCHEME | Medscheme | 012P |
| ONE PLAN MEDICAL INSURANCE | Oneplan Medical Insurance | 468P |
| OPMED | Opmed (NIA) | 142P |
| PARMED MEDICAL AID FUND | Medscheme | 143P |
| PG BISON MEDICAL AID SOCIETY | Allcare Administrators (Pty) Ltd | 586P |
| PG GROUP MEDICAL SCHEME | Metropolitan Health Group | 146P |
| PHAROS MEDICAL PLAN | Private Health Administrators (Pty) Ltd | 583P |
| PICK N PAY MEDICAL SCHEME | Metropolitan Health Group | 376P |
| PLATINUM HEALTH | Platinum Health | 266P |
| POLMED | Metropolitan Health Group | 219P |
| POLMED (IOD CLAIMS) | Metropolitan Health Group | 703P |
| PPN AECI | Medscheme | 417P |
| PPN BANKMED | Metropolitan Health Group | 426P |
| PPN CARECROSS | Carecross | 432P |
| PPN MEDIMED | Providence Health Risk Managers | 457P |
| PPN MINEMED | Providence Health Risk Managers | 456P |
| PPN POLMED | Metropolitan Health Group | 419P |
| PRIME CURE | Prime Cure | 642P |
| PROFMED | PPS Medical Scheme Administrators | 154P |
| PROSANO MEDICAL SCHEME | Sigma Health Fund Managers | 155P |
| PULA MEDICAL AID FUND | A.F.A. Administrators | 342P |
| QUANTUM MEDICAL AID SOCIETY | Discovery Health Administrators | 162P |
| RAND MUTUAL ASSURANCE | Rand Mutual Assurance | 818P |
| RAND WATER MEDICAL SCHEME | Rand Water Board | 607P |
| REMEDI MEDICAL AID SCHEME | Discovery Health Administrators | 161P |
| RENAISSANCE HEALTH MEDICAL AID FUND | Prosperity Health Namibia | 257P |
| RESOLUTION HEALTH MEDICAL SCHEME | Agility | 061P |
| RETAIL MEAT TRADE | Retail Meat Trade | 608P |
| RETAIL MEDICAL SCHEME | Discovery Health Administrators | 946P |
| RHODES UNIVERSITY MEDICAL SCHEME (RU MED) | Providence Health Risk Managers | 581P |
| SA BREWERIES MEDICAL AID SOCIETY | Momentum Metropolitan Investments (MMI) | 179P |
| SABC MEDICAL AID SCHEME | Medscheme | 176P |
| SAMWUMED | SAMWUmed | 611P |
| SAPPI MEDICAL AID SCHEME | Metropolitan Health Group | 174P |
| SASOLMED MEDICAL SCHEME | Medscheme | 175P |
| SEDMED MEDICAL SCHEME | SEDMED Medical Scheme | 022P |
| SELFMED MEDICAL SCHEME | Selfmed | 004P |
| SIZWE MEDICAL FUND | Sechaba Medical Solutions | 178P |
| SPECTRAMED | V Medical Aid Administrators | 522P |
| SPES BONA | Spes Bona | 614P |
| SPESBONA LIMPOPO | Spesbona Limpopo | 242P |
| SUREMED HEALTH | Providence Health Risk Managers | 072P |
| SWAZIMED | Medscheme | 240P |
| THEBEMED MEDICAL SCHEME | Thebe YaBophelo Healthcare | 769P |
| TIGER BRANDS MEDICAL SCHEME | Universal Healthcare Administrators (Pty) Ltd. | 228P |
| TOPMED MEDICAL SCHEME | Private Health Administrators (Pty) Ltd | 003P |
| TRANSMED MEDICAL FUND | Metropolitan Health Group | 194P |
| TRANSMED STATE PLUS NETWORK OPTION | Universal Healthcare Administrators (Pty) Ltd. | 229P |
| TSOGO SUN GROUP MEDICAL SCHEME | Discovery Health Administrators | 944P |
| UDIPA | Udipa Medical Aid | 869P |
| ULTRACARE | Ultracare | 615P |
| UMVUZO HEALTH MEDICAL SCHEME | Umvuzo Health Medical Scheme | 920P |
| UMVUZO HEALTH STANDARD AND ULTRA OPTION | Universal Healthcare Administrators (Pty) Ltd. | 233P |
| UNIV OF WITWATERSRAND STAFF MEDICAL AID SCHEME | Medscheme | 198P |
| UNIVERSAL HEALTH WORKERS PLAN | Universal Healthcare Administrators (Pty) Ltd. | 431P |
| UNIVERSITY OF KWAZULU NATAL MEDICAL SCHEME | Discovery Health Administrators | 197P |
| WCMAS: YEBO MED OPTION | Witbank Coal Medical Aid Society | 286P |
| WITBANK COALFIELDS MEDICAL AID SCHEME | Witbank Coal Medical Aid Society | 201P |
| WOOLTRU HEALTHCARE FUND | Metropolitan Health Group | 202P |
| WORKERS COMPENSATION ASSISTANCE | WCA Workers Compensation Assistance cc | 495P |
| XTRATA ALLOYS MEDICAL AID SCHEME | Medscheme | 181P |
| YARONA | SAPS | 028P |
| © 2013 MediSwitch (Pty) Ltd, All Rights | ||
| Reserved. |
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
Premier Practice Extended Consultation codeEffective January 2015, Discovery Health will require additional procedure codes for the Premier Practice extended consultation.
The agreement will be limited to GPs on Premier Practice which is an arrangement to define appropriate care delivery and benefit principles for the management of specified chronic conditions by GPs.
Based on the initial consultation the practice will have the opportunity to charge a higher consultation rate for an initial, once per annum, extended consultation by using the following billing code:
· PHPRO
· Description Personal Health Programme Consultation
· Tariff amount R600
It is important to note
Your urgent assistance in reviewing your PMA’s ability to manage alphanumeric procedure codes and confirming with Discovery Health, on your capacity to complete all development required to manage the new codes by the go live date of 1 January 2015 would be highly appreciated.
You are welcome to email me at carinam@discovery.co.za or Muneefa@discovery.co.za if you have any questions about this.
|
Rand Mutual claims submission and processes information sessions:
Rand Mutual Assurance (RMA) invites all medical service providers to the following information
sessions where important need-to-know information regarding RMA’s processes and claim
submissions, as well as introduction to RMA’s user-friendly medical portal will be discussed.
These sessions are intended for all Medical Service Providers, Healthcare Professionals and
facilities.
RSVP: Carika Pretorius
cpretorius@randmutual.co.za 010-214-3081
POTCHEFSTROOM,
11 May 2015, 18:00 – 20:00, North West university, 11 Hoffman Street, Potchefstroom
DURBAN (UMHLANGA),
14 May 2015, 18:00 – 20:00, Gateway Private Hospital, Training Room, 6
th
floor, 36 Aurora Drive, Umhlanga
EAST LONDON,
18 May 2015, 18:00 – 20:00, Premier Hotel, 22 Esplanade Street, East London
PORT ELIZABETH,
19 May 2015, 18:00 – 20:00, Protea Hotel Marine, Marine Drive, Port Elizabeth
VAAL TRIANGLE,
20 May 2015, 18:00 – 20:00, Quest North-West University, Curie Boulevard, Vanderbijlpark
PRETORIA,
25 May 2015, 18:00 – 20:00, Premier Hotel, 573 Kerk Street, Pretoria
JOHANNESBURG,
25 May 2015, 18:00 – 20:00, Sunnyside Park Hotel, Princess of Wales Terrace, Parktown
BLOEMFONTEIN,
28 May 2015, 18:00 – 20:00, Horizon Eye Care Centre (Bloemfontein Eye), 54 Pasteur Drive,
Hospital Park, Bloemfontein
| ICD10_3_Code | ICD10_3_Code_Desc | ICD10_Code | WHO_Full_Desc | Status | Comment |
| H54 | Visual impairment including blindness (binocular or monocular) | H54.7 | Unspecified visual loss | D | Discontinue code |
| I84 | Haemorrhoids | I84 | Haemorrhoids | D | Discontinue code |
| I84 | Haemorrhoids | I84.0 | Internal thrombosed haemorrhoids | D | Discontinue code |
| I84 | Haemorrhoids | I84.1 | Internal haemorrhoids with other complications | D | Discontinue code |
| I84 | Haemorrhoids | I84.2 | Internal haemorrhoids without complication | D | Discontinue code |
| I84 | Haemorrhoids | I84.3 | External thrombosed haemorrhoids | D | Discontinue code |
| I84 | Haemorrhoids | I84.4 | External haemorrhoids with other complications | D | Discontinue code |
| I84 | Haemorrhoids | I84.5 | External haemorrhoids without complication | D | Discontinue code |
| I84 | Haemorrhoids | I84.6 | Residual haemorrhoidal skin tags | D | Discontinue code |
| I84 | Haemorrhoids | I84.7 | Unspecified thrombosed haemorrhoids | D | Discontinue code |
| I84 | Haemorrhoids | I84.8 | Unspecified haemorrhoids with other complications | D | Discontinue code |
| I84 | Haemorrhoids | I84.9 | Unspecified haemorrhoids without complication | D | Discontinue code |
| K35 | Acute appendicitis | K35.0 | Acute appendicitis with generalized peritonitis | D | Discontinue code |
| K35 | Acute appendicitis | K35.1 | Acute appendicitis with peritoneal abscess | D | Discontinue code |
| K35 | Acute appendicitis | K35.9 | Acute appendicitis, unspecified | D | Discontinue code |
| K51 | Ulcerative colitis | K51.1 | Ulcerative (chronic) ileocolitis | D | Discontinue code |
| N18 | Chronic kidney disease | N18.0 | End-stage renal disease | D | Discontinue code |
| N18 | Chronic kidney disease | N18.8 | Other chronic renal failure | D | Discontinue code |
| R50 | Fever of other and unknown origin | R50.00 | Fever with chills | D | Code discontinued and ended on the 31/08/2007 |
| R50 | Fever of other and unknown origin | R50.10 | Persistent fever | D | Code discontinued and ended on the 31/08/2007 |
| X59 | Exposure to unspecified factor | X59.1 | Exposure to unspecified factor, residential institution | D | Discontinue code |
| X59 | Exposure to unspecified factor | X59.10 | Exposure to unspecified factor, residential institution, while engaged in sports activity | D | Discontinue code |
| X59 | Exposure to unspecified factor | X59.11 | Exposure to unspecified factor, residential institution, while engaged in leisure activity | D | Discontinue code |
| X59 | Exposure to unspecified factor | X59.12 | Exposure to unspecified factor, residential institution, while working for income | D | Discontinue code |
| X59 | Exposure to unspecified factor | X59.13 | Exposure to unspecified factor, residential institution, while engaged in other types of work | D | Discontinue code |
| X59 | Exposure to unspecified factor | X59.14 | Exposure to unspecified factor, residential institution, while resting, sleeping, eating or engaging in other vital activities | D | Discontinue code |
| X59 | Exposure to unspecified factor | X59.18 | Exposure to unspecified factor, residential institution, while engaged in other specified activities | D | Discontinue code |
| X59 | Exposure to unspecified factor | X59.19 | Exposure to unspecified factor, residential institution, during unspecified activity | D | Discontinue code |
| X59 | Exposure to unspecified factor | X59.2 | Exposure to unspecified factor, school, other institution and public administrative area | D | Discontinue code |
| X59 | Exposure to unspecified factor | X59.20 | Exposure to unspecified factor, school, other institution and public administrative area, while engaged in sports activity | D | Discontinue code |
| X59 | Exposure to unspecified factor | X59.21 | Exposure to unspecified factor, school, other institution and public administrative area, while engaged in leisure activity | D | Discontinue code |
| X59 | Exposure to unspecified factor | X59.22 | Exposure to unspecified factor, school, other institution and public administrative area, while working for income | D | Discontinue code |
| X59 | Exposure to unspecified factor | X59.23 | Exposure to unspecified factor, school, other institution and public administrative area, while engaged in other types of work | D | Discontinue code |
| X59 | Exposure to unspecified factor | X59.24 | Exposure to unspecified factor, school, other institution and public administrative area, while resting, sleeping, eating or engaging in other vital activities | D | Discontinue code |
| X59 | Exposure to unspecified factor | X59.28 | Exposure to unspecified factor, school, other institution and public administrative area, while engaged in other specified activities | D | Discontinue code |
| X59 | Exposure to unspecified factor | X59.29 | Exposure to unspecified factor, school, other institution and public administrative area, during unspecified activity | D | Discontinue code |
| X59 | Exposure to unspecified factor | X59.3 | Exposure to unspecified factor, sports and athletics area | D | Discontinue code |
| X59 | Exposure to unspecified factor | X59.30 | Exposure to unspecified factor, sports and athletics area, while engaged in sports activity | D | Discontinue code |
| X59 | Exposure to unspecified factor | X59.31 | Exposure to unspecified factor, sports and athletics area, while engaged in leisure activity | D | Discontinue code |
| X59 | Exposure to unspecified factor | X59.32 | Exposure to unspecified factor, sports and athletics area, while working for income | D | Discontinue code |
| X59 | Exposure to unspecified factor | X59.33 | Exposure to unspecified factor, sports and athletics area, while engaged in other types of work | D | Discontinue code |
| X59 | Exposure to unspecified factor | X59.34 | Exposure to unspecified factor, sports and athletics area, while resting, sleeping, eating or engaging in other vital activities | D | Discontinue code |
| X59 | Exposure to unspecified factor | X59.38 | Exposure to unspecified factor, sports and athletics area, while engaged in other specified activities | D | Discontinue code |
| X59 | Exposure to unspecified factor | X59.39 | Exposure to unspecified factor, sports and athletics area, during unspecified activity | D | Discontinue code |
| X59 | Exposure to unspecified factor | X59.4 | Exposure to unspecified factor, street and highway | D | Discontinue code |
| X59 | Exposure to unspecified factor | X59.40 | Exposure to unspecified factor, street and highway, while engaged in sports activity | D | Discontinue code |
| X59 | Exposure to unspecified factor | X59.41 | Exposure to unspecified factor, street and highway, while engaged in leisure activity | D | Discontinue code |
| X59 | Exposure to unspecified factor | X59.42 | Exposure to unspecified factor, street and highway, while working for income | D | Discontinue code |
| X59 | Exposure to unspecified factor | X59.43 | Exposure to unspecified factor, street and highway, while engaged in other types of work | D | Discontinue code |
| X59 | Exposure to unspecified factor | X59.44 | Exposure to unspecified factor, street and highway, while resting, sleeping, eating or engaging in other vital activities | D | Discontinue code |
| X59 | Exposure to unspecified factor | X59.48 | Exposure to unspecified factor, street and highway, while engaged in other specified activities | D | Discontinue code |
| X59 | Exposure to unspecified factor | X59.49 | Exposure to unspecified factor, street and highway, during unspecified activity | D | Discontinue code |
| X59 | Exposure to unspecified factor | X59.5 | Exposure to unspecified factor, trade and service area | D | Discontinue code |
| X59 | Exposure to unspecified factor | X59.50 | Exposure to unspecified factor, trade and service area, while engaged in sports activity | D | Discontinue code |
| X59 | Exposure to unspecified factor | X59.51 | Exposure to unspecified factor, trade and service area, while engaged in leisure activity | D | Discontinue code |
| X59 | Exposure to unspecified factor | X59.52 | Exposure to unspecified factor, trade and service area, while working for income | D | Discontinue code |
| X59 | Exposure to unspecified factor | X59.53 | Exposure to unspecified factor, trade and service area, while engaged in other types of work | D | Discontinue code |
| X59 | Exposure to unspecified factor | X59.54 | Exposure to unspecified factor, trade and service area, while resting, sleeping, eating or engaging in other vital activities | D | Discontinue code |
| X59 | Exposure to unspecified factor | X59.58 | Exposure to unspecified factor, trade and service area, while engaged in other specified activities | D | Discontinue code |
| X59 | Exposure to unspecified factor | X59.59 | Exposure to unspecified factor, trade and service area, during unspecified activity | D | Discontinue code |
| X59 | Exposure to unspecified factor | X59.6 | Exposure to unspecified factor, industrial and construction area | D | Discontinue code |
| X59 | Exposure to unspecified factor | X59.60 | Exposure to unspecified factor, industrial and construction area, while engaged in sports activity | D | Discontinue code |
| X59 | Exposure to unspecified factor | X59.61 | Exposure to unspecified factor, industrial and construction area, while engaged in leisure activity | D | Discontinue code |
| X59 | Exposure to unspecified factor | X59.62 | Exposure to unspecified factor, industrial and construction area, while working for income | D | Discontinue code |
| X59 | Exposure to unspecified factor | X59.63 | Exposure to unspecified factor, industrial and construction area, while engaged in other types of work | D | Discontinue code |
| X59 | Exposure to unspecified factor | X59.64 | Exposure to unspecified factor, industrial and construction area, while resting, sleeping, eating or engaging in other vital activities | D | Discontinue code |
| X59 | Exposure to unspecified factor | X59.68 | Exposure to unspecified factor, industrial and construction area, while engaged in other specified activities | D | Discontinue code |
| X59 | Exposure to unspecified factor | X59.69 | Exposure to unspecified factor, industrial and construction area, during unspecified activity | D | Discontinue code |
| X59 | Exposure to unspecified factor | X59.7 | Exposure to unspecified factor, farm | D | Discontinue code |
| X59 | Exposure to unspecified factor | X59.70 | Exposure to unspecified factor, farm, while engaged in sports activity | D | Discontinue code |
| X59 | Exposure to unspecified factor | X59.71 | Exposure to unspecified factor, farm, while engaged in leisure activity | D | Discontinue code |
| X59 | Exposure to unspecified factor | X59.72 | Exposure to unspecified factor, farm, while working for income | D | Discontinue code |
| X59 | Exposure to unspecified factor | X59.73 | Exposure to unspecified factor, farm, while engaged in other types of work | D | Discontinue code |
| X59 | Exposure to unspecified factor | X59.74 | Exposure to unspecified factor, farm, while resting, sleeping, eating or engaging in other vital activities | D | Discontinue code |
| X59 | Exposure to unspecified factor | X59.78 | Exposure to unspecified factor, farm, while engaged in other specified activities | D | Discontinue code |
| X59 | Exposure to unspecified factor | X59.79 | Exposure to unspecified factor, farm, during unspecified activity | D | Discontinue code |
| X59 | Exposure to unspecified factor | X59.8 | Exposure to unspecified factor, other specified places | D | Discontinue code |
| X59 | Exposure to unspecified factor | X59.80 | Exposure to unspecified factor, other specified places, while engaged in sports activity | D | Discontinue code |
| X59 | Exposure to unspecified factor | X59.81 | Exposure to unspecified factor, other specified places, while engaged in leisure activity | D | Discontinue code |
| X59 | Exposure to unspecified factor | X59.82 | Exposure to unspecified factor, other specified places, while working for income | D | Discontinue code |
| X59 | Exposure to unspecified factor | X59.83 | Exposure to unspecified factor, other specified places, while engaged in other types of work | D | Discontinue code |
| X59 | Exposure to unspecified factor | X59.84 | Exposure to unspecified factor, other specified places, while resting, sleeping, eating or engaging in other vital activities | D | Discontinue code |
| X59 | Exposure to unspecified factor | X59.88 | Exposure to unspecified factor, other specified places, while engaged in other specified activities | D | Discontinue code |
| X59 | Exposure to unspecified factor | X59.89 | Exposure to unspecified factor, other specified places, during unspecified activity | D | Discontinue code |
“With effect from 1 January 2011, reference pricing on PMB and chronic benefits will be introduced by CAMAF. This reference pricing includes therapeutic reference pricing and MMAP.
From 1 November 2010 you will receive a warning message for all patients with potential co-payments in 2011. The intention of this warning message is to encourage members to make an informed decision before Year End to:
o Change to an option with higher reference price limits before Year End; and/or
o Change their medication to a product below the reference price limits so as not to have any out-of-pocket co-payment.
CAMAF’s decision to introduce therapeutic reference pricing is in line with the industry trend to allow patients and their treating doctor’s choice and flexibility in the selection of required medication, while managing the Scheme’s financial risk. The reference pricing calculation will be applied by MediKredit at point of service and any reference pricing surcharge will be due by the patient and should be collected from the patient.
With the patient’s permission the provider may substitute the medication with a generic equivalent to reduce or negate the co-payment for the patient. In some instances, in order to reduce or negate co-payments, it may be necessary for the prescribing doctor to review the medication and prescribe a different drug from the same therapeutic class.
Alternatively, the member can investigate moving to an option which is more appropriate to the level of cover required in 2011.”