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Keeping you informed.
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Medical Practices
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Keeping you informed.
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In support of good clinical governance and to ensure clinically appropriate use of medication, effective 1 September 2016, Witbank Coalfields Medical Scheme will implement dosage limits to Schedule 1 to 3 Codeine containing products, submitted on the Acute options.
An accumulative dosage limit of 1 200mg of Codeine (across all the S1-S3 therapeutic classes containing Codeine) within a 30 days treatment cycle will be allowed.
For the period 1 September 2016 to 28 February 2017 when the dosage is exceeded a message will be returned to the PMS, warning that the member has exceeded the allowed dosage limit.
Effective 1 March 2017, once the accumulative dosage limit is exceeded; the cost for the additional quantity of the submitted product will be a surcharge to the member.
Bonitas, South Africa’s third largest medical scheme, is claiming victory in what it believes is the beginning of a competition and price war with private hospitals, notes Rapport.
The newspaper reported that Bonitas announced the exclusion of 14 large Life Healthcarehospitals for its 750,000 insured lives and warned they may do the same with other major groups.
Bonitas spends R360m annually at the 14 Life hospitals, and has imposed a 30% co-payment for members who continue to use these hospitals. Life Healthcare head of financers’ relations, Matthew Prior, says the group has waived the 30% so that Life patients who are members of Bonitas may continue to use their facilities without a financial burden.
The report says that according to acting chief officer Gerhard van Emmenis, this effectively means a 30% discount for Bonitas and a much better deal for the scheme. ‘I think every medical scheme is now standing at Life’s door asking why they cannot also get a 30% discount.’
He says the gap between the tariffs negotiated by the two largest schemes – Discoveryand GEMS – and what smaller schemes pay hospitals is getting wider. Bonitas plans to target the National Hospital Network (NHN) – a group of independent private hospitals – next.
NHN has an exemption from the Competition Commission to bargain as a collective with medical schemes, but Bonitas is planning to challenge this practice in court.
We are living in an increasingly digital world and the speed of technological change means that healthcare providers often struggle to keep. Moving to the cloud is a solution that offers distinctive benefits, but at the same time introducing additional risks.
Yes, the future is mobile. And increasingly medical and other healthcare practices are feeling inclined to follow the trend: the flexibility of being able to control their businesses from the palm of their hand.
Moving to the cloud comes with a fair amount of uncertainty. Concerns regarding malware, compliance and security are probably the first on the list but are not the only point of hesitation.
Lack of internet access, hardware failures, the fear of downtime, the loss of important data are all reasons why there is apprehension to cloud migration.
There are indeed those healthcare practices that have taken the leap and moved to the cloud, albeit settling for software with reduced feature set.
Yes, web based software in general, does not have the rich feature set that pedigreed desktop software such as Medinol has.
Web based medical billing software does sacrifice quite a lot compared to desktop software because it has to be downloaded from the web as it is needed.
Desktop medical billing software, on the other hand, resides on the local computer, which results in a lot faster and responsive user experience.
In a recent study 65% of business executives said that moving to the cloud has freed up IT resources to work on more strategic tasks and 64% added that these initiatives were implemented faster.
Despite increased efficiency, there are few myths being touted as to why moving your practice to the cloud is an option that should be considered as superior.
For practical purposes most cloud providers are located locally. They use the best hardware, software and skills. Data centres are also required to adhere to a variety of audits and industry standards. But because they are faceless, and often time their locale is not disclosed, can you really trust them to their commitment?
In the cloud, a specialist will take care of the security for you and every time you connect – you will hopefully have access to the latest version of applications. This is largely beyond your control, so you really need to be able to trust your cloud provider.
Hard drives packed with patient data lost to theft or fire is no longer a worry. A good cloud application will keep your data backed up to the last 24 hours without any need for special action from your side. Of course, you will still need to be concerned if your local computer equipment is at risk, but still, the reequirements are less onerous.
Cloud provides a potential productivity increase of up to 400% says cloud providers as they tout their services. They seem to omit mentioning forget that there is still a cost involved in maintaining the connecting computer equipment.
So in summary, while there are distinct advantages in moviong your medical practice to the cloud, there are still very distinct advantages of running both the business and clinical sides of your practice on a local basis. The risks are still too big to migrate to web basedmedical billing software.
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QEDI Code |
MediSwitch |
Scheme Name |
Administrator Name |
| 027P | SHAE0000 | AECI MEDICAL AID SOCIETY | Medscheme |
| *215P | AMAS0002 | AECI MEDICAL AID SOCIETY VALUE OPTION | Universal Healthcare Administrators (Pty) Ltd. |
| 290P | ABRO0001 | AFA BROADREACH | Medscheme |
| 304P | ACOR0001 | AFA CORPORATE | Medscheme |
| 248P | BKAE0000 | AFROX MEDICAL AID SOCIETY | Metropolitan Health Group |
| 224P | MSAM0002 | ALLIANCE MIDMED MEDICAL SCHEME | Private Health Administrators (Pty) Ltd |
| 033P | ALAT0000 | ALTRON MEDICAL AID SCHEME | Discovery Health Administrators |
| 037P | NPAM0000 | ANGLO MEDICAL SCHEME | Momentum Metropolitan Investments (MMI) |
| 036P | DIAV0000 | ANGLOVAAL GROUP MEDICAL SCHEME | Discovery Health Administrators |
| 042P | BKAC0000 | BANKMED MEDICAL SCHEME | Metropolitan Health Group |
| 043P | MSBR0000 | BARLOWORLD MEDICAL SCHEME | Medscheme |
| 733P | BCIM0001 | BCIMA (BUILDING AND CONSTRUCTION INDUSTRY MEDICAL AID FUND) | Universal Healthcare Administrators (Pty) Ltd. |
| 045P | BEBE0000 | BESTMED MEDICAL SCHEME | Sanlam Health |
| 048P | MSBW0000 | BMW EMPLOYEES MEDICAL AID SOCIETY | Medscheme |
| 595P | BSBO0000 | BOMAID | BOMaid Medical Aid |
| 050P | MSBS0000 | BONITAS MEDICAL FUND | Medscheme |
| 964P | BBON0001 | BONITAS MEDICAL FUND BONCAP OPTION | Medscheme |
| 594P | AFBO0000 | BOTSWANA PUBLIC OFFICES | A.F.A. Administrators |
| 056P | BKAJ0000 | BP SOUTHERN AFRICA MEDICAL AID SOCIETY | Metropolitan Health Group |
| 593P | INPE0000 | BUILDING INDUSTRIES P.E. | Industrial Council P.E. |
| 079P | CAAA0000 | CAMAF | Eternity Private Health Fund Administrator (Pty) |
| 052P | CMPL0000 | CAPE MEDICAL PLAN | Cape Medical Plan |
| 561P | CARE0006 | CARECROSS | Carecross |
| 389P | CFDA0001 | CENTRE FOR DIABETES AND ENDOCRINOLOGY (CDE) | Centre For Diabetes And Endocrinology (CDE) |
| 596P | CFCF0000 | CHARIOT FINANCIAL SERVICES MEDICAL FUND | Chariot Financial Services Medical Fund |
| 009P | IHCO0000 | COMMUNITY MEDICAL AID SCHEME (COMMED) | Allcare Administrators (Pty) Ltd |
| 129P | SSCC0000 | COMPCARE MEDICAL SCHEME | Universal Healthcare Administrators (Pty) Ltd. |
| 704P | CIOD0001 | COMPSOL (IOD CLAIMS) | IOD Claims: Compsol |
| 066P | DBDB0000 | DE BEERS BENEFIT SOCIETY | De Beers Benefit Society |
| 406P | DRCC0001 | DENTAL RISK COMPANY | DRC Dental Risk Company |
| 125P | DHEA0000 | DISCOVERY HEALTH MEDICAL SCHEME | Discovery Health Administrators |
| *226P | DOME0001 | DOMESTICARE | Carecross |
| 289P | EMCC0008 | EMERGING MARKET HEALTHCARE | Emerging Market Healthcare |
| 269P | BKAI0000 | ENGEN MEDICAL BENEFIT FUND | Metropolitan Health Group |
| 782P | EHEA0001 | EYETHUMED MEDICAL SCHEME | Medscheme |
| 859P | FARA0001 | FARANANI HEALTH SOLUTIONS | Faranani Health Solutions |
| 160P | OPLA0001 | FEDHEALTH MEDICAL SCHEME | Medscheme |
| 779P | FISH0001 | FISHING INDUSTRY MEDICAL SCHEME (FISHMED) | Metropolitan Health Group |
| 083P | BKAL0000 | FOSCHINI GROUP MEDICAL SCHEME | Discovery Health Administrators |
| 470P | FURN0001 | FURNMED | Eminent Wealth Consult Pty Ltd |
| 518P | GMSC0001 | GENESIS MEDICAL SCHEME | Definiti Medical Fund Managers |
| 349P | GETM0001 | GETMED | GETMED |
| 381P | GSWA0001 | GETMED AFRICA (SWAZILAND) | GETMED Swaziland |
| 116P | DIME0000 | GOLD FIELDS MEDICAL SCHEME | Providence Health Risk Managers |
| 363P | GARR0000 | GOLDEN ARROW EMPLOYEES MEDICAL BENEFIT FUND | Metropolitan Health Group |
| 875P | GEMS0001 | GOVERNMENT EMPLOYEES MEDICAL SCHEME (GEMS EMERALD OPTION) | Metropolitan Health Group |
| *925P | GEOP0001 | GOVERNMENT EMPLOYEES MEDICAL SCHEME (GEMS ONYX OPTION) | Metropolitan Health Group |
| 926P | GROP0001 | GOVERNMENT EMPLOYEES MEDICAL SCHEME (GEMS RUBY OPTION) | Metropolitan Health Group |
| 259P | STGR0000 | GRINTEK ELECTRONICS MEDICAL AID SCHEME | Universal Healthcare Administrators (Pty) Ltd. |
| 597P | IDHA0000 | HAIRDRESSING SICK BENEFIT FUND CAPE TOWN | Hairdressing Sick Benefit Fund |
| 870P | HARM0001 | HARMONY HEALTH SERVICES | Providence Health Risk Managers |
| 444P | HMSC0001 | HORIZON MEDICAL SCHEME | Medscheme |
| 523P | THHM0000 | HOSMED MEDICAL AID SCHEME | Thebe YaBophelo Healthcare |
| 943P | ISMA0001 | IBM SA MEDICAL AID SOCIETY | Discovery Health Administrators |
| 439P | IMPL0001 | IMPALA MEDICAL PLAN | Providence Health Risk Managers |
| 364P | OMIM0000 | IMPERIAL GROUP MEDICAL SCHEME | Metropolitan Health Group |
| 510P | MUNI0000 | KEYHEALTH | PPS Medical Scheme Administrators |
| 525P | LHEA0001 | LA HEALTH | Discovery Health Administrators |
| 099P | MSLI0000 | LIBCARE MEDICAL SCHEME | V Medical Aid Administrators |
| 008P | LBLU0001 | LIBERTY BLUE MEDICAL SCHEME | V Medical Aid Administrators |
| 101P | LIPS0000 | LIBERTY HEALTH MEDICAL SCHEME | V Medical Aid Administrators |
| 945P | LMSC0001 | LONMIN MEDICAL SCHEME | Discovery Health Administrators |
| 104P | NMMD0000 | MALCOR MEDICAL SCHEME | Allcare Administrators (Pty) Ltd |
| 598P | MASC0000 | MASCA ZIMBABWE | MASCA Zimbabwe |
| 038P | MSSS0000 | MASSMART HEALTH PLAN | Medscheme |
| 180P | DCME0003 | MB MED | Medscheme |
| 256P | MGFM0001 | MEDIHELP | Medihelp |
| 265P | MSDI0000 | MEDIMED MEDICAL SCHEME | Providence Health Risk Managers |
| *168P | MSFU0001 | MEDIONE SICK FUND | Oneplan Medical Insurance |
| 250P | OMDP0000 | MEDIPOS MEDICAL SCHEME | Metropolitan Health Group |
| 111P | MSMS0000 | MEDSHIELD MEDICAL SCHEME | Medshield Administrators |
| 121P | MMSC0000 | METROPOLITAN MEDICAL SCHEME | Metropolitan Health Group |
| 378P | CAAC0000 | MINEMED MEDICAL SCHEME | Providence Health Risk Managers |
| 362P | MMSC0001 | MMED OPTION OF THE NASPERS MEDICAL FUND | Discovery Health Administrators |
| 237P | MHAF0001 | MOMENTUM HEALTH AFRICA | Momentum: HDS Medical Management |
| 822P | MHEA0007 | MOMENTUM HEALTH MEDICAL SCHEME | Momentum Metropolitan Investments (MMI) |
| 940P | MHCA0001 | MOTO HEALTHCARE | Momentum Metropolitan Investments (MMI) |
| 292P | MINT0001 | MSO INTERNATIONAL | MSO |
| 206P | MSAS0000 | NAMIBIA HEALTH PLAN | Medscheme Namibia |
| 600P | MSAU0000 | NAMIBIA IND MEDICAL AID | Medscheme Namibia |
| 046P | NMAK0000 | NAMPAK SA MEDICAL SCHEME | Momentum Metropolitan Investments (MMI) |
| 512P | NSNP0000 | NASPERS MEDICAL FUND | Discovery Health Administrators |
| 010P | NWFH0001 | NBCRFLI WELLNESS FUND HEALTH PLAN | Universal Healthcare Administrators (Pty) Ltd. |
| 016P | OMNE0000 | NEDGROUP MEDICAL AID SCHEME | Medscheme |
| 067P | NPMS0000 | NETCARE MEDICAL SCHEME | PrimeMed |
| 624P | NSBS0001 | NUFSWSA SICK BENEFIT SOCIETY | Eminent Wealth Consult Pty Ltd |
| 012P | OMOL0000 | OLD MUTUAL STAFF MEDICAL AID SCHEME | Medscheme |
| 468P | OPMI0001 | ONE PLAN MEDICAL INSURANCE | Oneplan Medical Insurance |
| 142P | NASE0000 | OPMED | Opmed (NIA) |
| 143P | MSPA0000 | PARMED MEDICAL AID FUND | Medscheme |
| 586P | DEAN0000 | PG BISON MEDICAL AID SOCIETY | Allcare Administrators (Pty) Ltd |
| 146P | NMPS0000 | PG GROUP MEDICAL SCHEME | Metropolitan Health Group |
| 583P | PVPH0000 | PHAROS MEDICAL PLAN | Private Health Administrators (Pty) Ltd |
| 376P | DEAO0000 | PICK N PAY MEDICAL SCHEME | Metropolitan Health Group |
| 266P | MSAP0001 | PLATINUM HEALTH | Platinum Health |
| 219P | MHPO0001 | POLMED | Metropolitan Health Group |
| 703P | PIOD0001 | POLMED (IOD CLAIMS) | Metropolitan Health Group |
| 417P | PAEC0001 | PPN AECI | Medscheme |
| 426P | PBAN0001 | PPN BANKMED | Metropolitan Health Group |
| 432P | PCAR0001 | PPN CARECROSS | Carecross |
| 457P | PMED0018 | PPN MEDIMED | Providence Health Risk Managers |
| 456P | PMIN0001 | PPN MINEMED | Providence Health Risk Managers |
| 419P | PPOL0001 | PPN POLMED | Metropolitan Health Group |
| 642P | PCUR0001 | PRIME CURE | Prime Cure |
| 154P | PFPO0000 | PROFMED | PPS Medical Scheme Administrators |
| 155P | SGPS0000 | PROSANO MEDICAL SCHEME | Sigma Health Fund Managers |
| 342P | PULA0001 | PULA MEDICAL AID FUND | A.F.A. Administrators |
| 162P | QMAS0002 | QUANTUM MEDICAL AID SOCIETY | Discovery Health Administrators |
| 818P | RMAS0001 | RAND MUTUAL ASSURANCE | Rand Mutual Assurance |
| 607P | RAWB0000 | RAND WATER MEDICAL SCHEME | Rand Water Board |
| 161P | MSRM0000 | REMEDI MEDICAL AID SCHEME | Discovery Health Administrators |
| 257P | RHMF0001 | RENAISSANCE HEALTH MEDICAL AID FUND | Prosperity Health Namibia |
| 061P | BKAO0000 | RESOLUTION HEALTH MEDICAL SCHEME | Agility |
| 608P | REMT0000 | RETAIL MEAT TRADE | Retail Meat Trade |
| 946P | RMSC0001 | RETAIL MEDICAL SCHEME | Discovery Health Administrators |
| 581P | TEMS0001 | RHODES UNIVERSITY MEDICAL SCHEME (RU MED) | Providence Health Risk Managers |
| 179P | MSBI0000 | SA BREWERIES MEDICAL AID SOCIETY | Momentum Metropolitan Investments (MMI) |
| 176P | MSAG0000 | SABC MEDICAL AID SCHEME | Medscheme |
| 611P | SAMW0001 | SAMWUMED | SAMWUmed |
| 174P | NMSP0000 | SAPPI MEDICAL AID SCHEME | Metropolitan Health Group |
| 175P | MSOI0000 | SASOLMED MEDICAL SCHEME | Medscheme |
| 022P | SMSC0003 | SEDMED MEDICAL SCHEME | SEDMED Medical Scheme |
| 004P | SHSF0000 | SELFMED MEDICAL SCHEME | Selfmed |
| 178P | SZWE0000 | SIZWE MEDICAL FUND | Sechaba Medical Solutions |
| 522P | ROSP0000 | SPECTRAMED | V Medical Aid Administrators |
| 614P | SPSB0000 | SPES BONA | Spes Bona |
| 072P | DEAC0000 | SUREMED HEALTH | Providence Health Risk Managers |
| 240P | MSSW0000 | SWAZIMED | Medscheme |
| 769P | TBEN0001 | THEBEMED MEDICAL SCHEME | Thebe YaBophelo Healthcare |
| 228P | TIGE0000 | TIGER BRANDS MEDICAL SCHEME | Universal Healthcare Administrators (Pty) Ltd. |
| 003P | BKTE0001 | TOPMED MEDICAL SCHEME | Momentum Metropolitan Investments (MMI) |
| 194P | TRTR0000 | TRANSMED MEDICAL FUND | Metropolitan Health Group |
| *229P | TSPN0001 | TRANSMED STATE PLUS NETWORK OPTION | Universal Healthcare Administrators (Pty) Ltd. |
| 944P | TSGM0001 | TSOGO SUN GROUP MEDICAL SCHEME | Discovery Health Administrators |
| 869P | UMSC0001 | UDIPA | Udipa Medical Aid |
| 615P | ULUM0000 | ULTRACARE | Ultracare |
| 920P | UHMS0001 | UMVUZO HEALTH MEDICAL SCHEME | Umvuzo Health Medical Scheme |
| *233P | UHSA0001 | UMVUZO HEALTH STANDARD AND ULTRA OPTION | Universal Healthcare Administrators (Pty) Ltd. |
| 198P | MSUN0000 | UNIV OF WITWATERSRAND STAFF MEDICAL AID SCHEME | Medscheme |
| 431P | UHEA0001 | UNIVERSAL HEALTH WORKERS PLAN | Universal Healthcare Administrators (Pty) Ltd. |
| 197P | MSAV0000 | UNIVERSITY OF KWAZULU NATAL MEDICAL SCHEME | Discovery Health Administrators |
| 286P | WYMO0001 | WCMAS: YEBO MED OPTION | Witbank Coal Medical Aid Society |
| 201P | MKWC0000 | WITBANK COALFIELDS MEDICAL AID SCHEME | Witbank Coal Medical Aid Society |
| 202P | DIWO0000 | WOOLTRU HEALTHCARE FUND | Metropolitan Health Group |
| 495P | WCAS0001 | WORKERS COMPENSATION ASSISTANCE | WCA Workers Compensation Assistance cc |
| 910P | WORL0001 | WORLDBANK | Momentum Metropolitan Investments (MMI) |
| 181P | XTRA0001 | XTRATA ALLOYS MEDICAL AID SCHEME | Medscheme |
| 028P | YARO0001 | YARONA | SAPS |
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Please be advised that since 1 January 2016 GEMS has been processing claims via Medikredit.
New submitting codes for the submission of dispensing doctor claims have been assigned and have been updated in the Medprax data files.
Please note the Dispensing fee for Gems SEP and Non-SEP items is as follows:
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