GEMS Tanzanite Beryl Adherence Letter
As a network provider your compliance with GEMS protocols are being reviewed.
Practice Management
Practice Management
2015 Golden Arrow Medical Billing
2015 Golden Arrow Medical Billing
Date: 18 Nov 2018
GOLDEN ARROW EMPLOYEES’ MEDICAL BENEFIT FUND
GENERAL PRACTITIONER FEE SCHEDULE FOR 2015 Tariff item |
Tariff code |
2015 total amount |
Consultation: including all acute medication administered or dispensed (dispensing doctor)* |
0190 |
R358.60 |
Consultation: includes medication administered (non-dispensing doctor)* |
0190 |
R269.00 |
Follow-up consultation: for dispensing doctor** |
0192 |
R191.90 |
Follow-up consultation: for non-dispensing doctor |
0192 |
R191.90 |
House visits: including all acute medication administered or dispensed |
0145 |
R394.50 |
Emergency house visits during the night and over weekends: including all acute medication administered or dispensed |
0146 |
R538.00 |
* The consultation tariff includes writing of any prescriptions, chronic medication applications and special motivations.
** An additional R66.00 will be paid if medication is dispensed, on condition that details of dispensed medication (medicine code – NAPPI) are submitted with the account. For easy access to NAPPI codes, click here.
Note: Kindly view tariff codes 0145 and 0146 as global fees for these specific services. They can, therefore, not be billed together with 0190.
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Hearing Aid NAPPI Codes
Hearing Aid NAPPI Codes
Date 29 June 2018
Dear Healthcare Provider,
From 1 January 2017, all hearing aid claims will require the submission of a valid NAPPI code. From 1 April 2017 any hearing aid claim submitted without a valid NAPPI code, will be rejected and a unique rejection code will alert you and your patient of the NAPPI code requirement to rectify this in order to process and pay your claim.
Nappi Codes
Based on the definition in the Medicines and Related Substances Control Act (No 101 of 1965), hearing aids fall within the category termed “medical devices”. In the medical aid industry, the current standard process is that medical devices are identified via unique NAPPI codes. The submission of a NAPPI code with any medical device is an acceptable and standard claims submission norm. It allows for transparent product identification and pricing. The NAPPI code thus enables the processing of claims on a uniform basis, subject to scheme specific benefits and rules.
Claims submission
We have been advised that when you submit your claim for tariff code 821830 or 83051 (global charge for supply and fitting of hearing aid and follow-up), ensure that the NAPPI code is submitted in the descriptor field of the claim. The actual price of the NAPPI code is not required on the claim. The claimed amount for these two tariff codes should be the composite of the cost of the hearing aid and the cost of the associated professional fees.
Medprax Nappi File
We have included all valid NAPPI codes for hearing aids in our Material file. These include the correct pricing for each hearing aid and device, and will be automatically imported into your software when you run your weekly update. You are able to charge the correct price according to the medical aid reimbursement rate. Your software can assist you should you wish to only claim the amount for the tariff codes and submit the NAPPI code at a zero price.
Contact us
Please do not hesitate to contact us should you wish to subscribe to the weekly Material file update.
If you have any questions or need assistance in understanding the requirements for the above hearing aid claims.
Karen Colby
031 9049208
karen@medprax.co.za
DENTAL HEALTH MANAGEMENT PROGRAMME 2017
Applicable to the following constituent medical schemes:
- BP Medical Aid Society
- Engen Medical Benefit Fund
- Fishing Industry Medical Scheme (Fishmed)
- Golden Arrow Employees’ Medical Benefit Fund
- Imperialmed
- MEDiPOS Medical Scheme
- Metropolitan Medical Scheme
- South African Breweries (SAB) Medical Aid
- Wooltru Healthcare Fund
Medihelp Pensioners Migrated to Gems
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