BestMed now reali-time live through MediSwitch
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brought to you by best practice management software
Practice Management
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brought to you by best practice management software
CAMAF:
1. IMMUNISATION BENEFITS FOR 2014
SCHEME/PLAN IMMUNISATION MAX
ALLIANCE R3800.00 per beneficiary per annum.
DOUBLE PLUS
R1890.00 per Adult per annum (22 years and older)
R3150.00 per Child per annum (0 – 21 years)
VITAL R1260.00 per beneficiary per annum.
ESSENTIAL PLUS R1260.00 per beneficiary per annum.
FIRST CHOICE R1260.00 per beneficiary per annum.
NETWORK CHOICE R1260.00 per beneficiary per annum.
2. ACUTE MEDICINE BENEFIT CHANGE:
Effective 1 January 2015, 2nd and 3rd line anti-depressants, inhalers and Nexiam 40mg will be allowed 3 fills from the Acute/Savings
benefit. Rejection RMR 558 “Individual Protocol Quantity Exceeded” will be returned to the provider on the 4th fill if these items
have not yet been authorised on Chronic.
KEYHEALTH:
1. CHRONIC BENEFITS FOR EQUILIBRIUM PLAN MEMBERS
Effective 1 January 2015, the following Chronic conditions will be covered for authorised KeyHealth Equilibrium option members. A
10% co-payment will apply. An additional 30% co-payment will apply if dispensed by a non-DSP pharmacy.
Allergic Rhinitis (Patients under age 21)
Acne (Patients under age 21)
Attention Deficit Hyperactivity Disorder (ADHD) and Attention Deficit Disorder (ADD) (Patients under age 21)
2. PRE-NATAL VITAMIN BENEFITS
In 2015, based on registration on the program, pre-natal vitamins, to the value of R1500.00 per pregnant female (for the duration of
the pregnancy) will be covered from the Health Booster benefit.
3. HEALTH ASSESMENT BENEFIT INCREASE
Effective 1 January 2014 reimbursement of KeyHealth Health Assessment tests submitted on the customised tariff code indicated in
the table below will increase to R110.00
NAPPI CODE DESCRIPTION PRICE
716769
Blood Pressure Measurements
R110.00
Health Assessment – Blood Glucose Screening (finger prick)
Health Assessment – Cholesterol Screening (finger prick)
Health Assessment – Body Mass Index
Phlebotomy for PSA test
Brought to you by: Medinol Medical Billing and Claims Software
Electronic claims to be sent via MediSwitch EDI.
Universal’s telephone number is: 086 168 6278.
They are the administrators for Transmed’s State+ network option.
So firstly, inside Medinol … go into Files -> Medical Aid … then ADD a new medical aid called Transmed-Universal …. give it a Medical aid code let’s say TU
Be sure to enter the EDI code as: 194
Save this new medical aid.
Now re-enter any members covered by this option as members of the newly created TU.
Reinvoice them using the new member codes.
Create Batch and submit to Medi-Switch.
From Daily Business News:
THE INTERNET of Things is evolving quickly, and on a global scale. The healthcare industry has cottoned on to this trend and already we are seeing a host of applications and connected devices entering the market, bearing the promise of improving the lives of patients and healthcare practitioners alike. The benefits of IoT extend well beyond health and fitness monitoring, however, and can help to smooth the interaction process between healthcare and medical aid providers as well as their clients writes Andre Deetlefs.
The impact of IoT on healthcare
From a healthcare monitoring perspective, the introduction of a variety of connected wearable devices, sensors and health applications have emerged to track a variety of common health concerns. People now have access to a multitude of health-related data from heart rates and fitness levels, to blood pressure, sleep patterns, insulin levels and even the dispensing of medication. These devices – both wearable and in the form of smart phone applications – use the Internet to communicate data back to medical aids and healthcare providers. The steady flow of information keeps them apprised of the health state of the wearer, or user, and helps them to avert worsened conditions.
Healthcare providers and medical aids are finding a wealth of value through the incoming stream of data from these devices. Leveraging the likes of Artificial Intelligence (AI) and Machine Learning (ML), they are able to do more with this data than ever before. Data analysis helps them to track trends and identify common problems, risks and solutions, which enables them to make greater medicinal strides. Many incurable disorders can now be managed easily and in an automated fashion, freeing up doctors’ time for research, and providing patients with better quality of life.
IoT is also helping healthcare providers and medical aids in other areas such as in-hospital vital sign monitoring, inventory and asset tracking and logistics. A key area that remains largely unexplored however, is the benefit of IoT on healthcare contact centres.
IoT improves CX
Customer experience (CX) is lauded as the new mark of customer loyalty. In the digital age, where most services are available at the click of a button, customers move swiftly between service providers when their experience with a provider is less than satisfactory. The same is true of healthcare and medical aid providers.
Many people still experience the frustration of repeatedly providing details to representatives of healthcare or medical aid providers. Time and again customers are prompted for the same information, having to fill in the same forms or needing to confirm the same details with a contact centre agent. A few medical aids and healthcare practitioners, as well as third party organisations however, are discovering that they can tap into the data being generated by connected devices and sensors to auto-complete their customer profiles. By having all their customers’ relevant information centrally stored and on-hand when customers contact them. They are providing better, faster service to customers while simultaneously accessing vital and accurate information that they require.
While some healthcare providers and medical aids are using IoT technology themselves to verify the accuracy and completeness of their databases, third party organisations are also emerging with applications that assist customers while providing an accessible database to healthcare and insurance providers. This must however be approved by the customer. The likes of Logbox have recently been brought to light in South Africa; an application which collates a person’s medical history and personal information on a secure platform and allows them to share it with doctors, hospitals and medical aid providers. This process helps save time, while giving providers ease of access to customer information. Connected devices which tie into applications such as Logbox can ensure that data collection is both accurate and automatic.
IoT to prevent fraud
A common issue experienced by both healthcare providers and medical aids, is the incorrect relay of information by customers. For example, a person applying for medical aid may state that they are healthy when in fact they may have a pre-existing medical condition. A sensor or connected device would be able to easily counter such claims, providing the contact centre agent with accurate information on the state of the person’s health, depending on the type of mechanism.
In the event of medical aid claims, IoT devices can also prevent fraud by verifying the authenticity of the individual’s claim. Medical aid contact centre agents would easily be able to access the claimant’s accurate medical history and records, through automated data delivery, and validate the necessity of the procedure.
Fraud from healthcare providers is also a lurking problem. Greedy practitioners may recommend more expensive medication, or unnecessary procedures anticipating higher returns. An analysis of data supplied by an IoT enabled device could easily refute the need for any recommended procedure and may even be able to suggest a more suitable solution, with the ongoing application of AI and ML.
IoT for healthcare
IoT, and more specifically the data it generates, opens the door to a world of possibilities for the healthcare industry. Whether applied to improve lives and control health disorders, or used to track and trace hospital assets; perhaps to administer medication, or facilitate smoother interactions between healthcare providers and customers; or possibly to prevent fraudulent activity, one thing is certain: IoT benefits the entire healthcare value chain and. If not already in use, IoT should form part of any healthcare and medical aid provider’s digital strategy.