1. New Mamoth Health Scheme Information:
Mamoth Health, a self administered scheme, will be processing via MediKredit with effect from 1 February 2012. New acute and chronic option codes as indicated in the summary table have been assigned for the processing of all plans.
2. HEALTHNET
2.1 Claims:
a) Claims should be submitted via HealthNet
b) Retain original scripts for record and audit purposes
2.2 Validation:
HealthNet will validate:
a) Membership number
b) Date of birth
c) Dependent Code
2.3 Networks:
HealthNet will accommodate all networks as agreed to with the scheme.
2.4 Mark‐up & Dispensing Fee
a) Schedule 0 and non‐scheduled items calculated on published wholesale price : 29.64% (Incl. VAT)
b) Schedule 1 to 7 calculated on Single Exit Price Pharmacy Claim (with Prescription): 29.64% ‐ Max R29.64 (Incl. VAT)
2.5 Membership Number
a) Total length: 9 digits
2.6 Stale Claim Period
120 Days
2.7 On‐line Reversal Period
120 Days
3. PAYMENT INFORMATION
MediKredit will be paying providers on behalf of the scheme.
SUMMARY OF RULES:
Momoth Health Acute
Mamoth Health Chronic
For more info: Medikredit 0860 932 273