The Employer (Government) has taken the decision to migrate a group of State pensioners, who retired before 1 July 1992 from the Public Service, from Medihelp to the Government Employees Medical Scheme (GEMS) with effect from 1 April 2012. The members who will be migrating have been issued new GEMS membership numbers.

In order to assist GEMS in making this transition as efficient as possible with minimum disruption of healthcare services for its new members, we have received the list of authorisations from Medihelp that is currently being transferred to the GEMS membership numbers.

All healthcare providers are kindly requested to note and engage with GEMS, on the contact details provided below, regarding the treatment and authorisation requirements for these members. Where a member is admitted in hospital during the transition period, a new authorisation to claim for period commencing 1 April 2012 will be required. If an authorisation for treatment before 31 March 2012 was obtained from Medihelp, it is important that you close off the files and claims for the affected patients at midnight 31 March 2012.

Claims for treatment up to and including 31 March 2012 must be submitted to Medihelp and claims from 1 April 2012 must be submitted to GEMS.

Please note that the GEMS Scheme rules, clinical protocols and benefit entitlements will apply and these may result in a different outcome with regard to the authorisation request.

Contact details
Tel: 0860 00 4367 (GEMS)
Fax: 0861 00 4367
Email: chronicauths@gems.gov.zaor hospitalauths@gems.gov.za

List of Medical Aid and Administrator Websites

Compiled by Better Practice Management

Our Medical Billing Software, Medinol has recently been updated to handle the growing trend towards healthcare providers contracting out.

Many of the medical aid scheme websites listed below offer a provider portal that you’ll need to register with first, in order to gain access. We recommend you do this for your bigger medical schemes, while at the same time adding the web address (url) to your list of favorites. Of course, the best way to claim from the medical schemes is via EDI.

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Click here for Medical Aid Telephone Number or Contact Details.