IMPORTANT: Changes to POLMED Claims Submission Procedure Effective 01 July 2024
- Starting 01 July 2024, Family Practitioners will be required to submit consultation claims according to the POLMED Network consultation tariff rate.
- In addition, and similar to other Medscheme-administered funders, the REPI² practice-specific enhanced fees will automatically appear on the remittance advice as two separate bi-monthly entries, in line with the REPI² performance category, and need not be claimed for.
- From 01 July 2024, your practice will therefore no longer need to submit consultation claims according to the practice specific ‘POLMED FP Profile’ enhanced fee, as previously indicated in the POLMED FP Profile.
- The purpose of this update is to simplify and streamline the day-to-day administration for POLMED Network Family Practitioners.
POLMED deeply values all Family Practitioners as indispensable partners, and invaluable in providing exceptional care to POLMED members.
POLMED is therefore committed to continually refining and enhancing operational and strategic components to assist Family Practitioners in delivering high-quality, efficient healthcare for all.
- What is the single POLMED Network Consultation Tariff Rate for 2024, to be claimed starting 01 July 2024?
POLMED New Payment Structure Effective 01 July 2024 | Base Network Tariff Rate |
014 General Practitioner | R 485.60 |
015 Specialist Family Physician | R 653.40 |
- What tariff rates should NOT be claimed as of 01 July 2024?
POLMED FP Profile Category | Rate NOT to claim starting 1 July 2024 |
POLMED FP Network Consultation Rate Fee Category 1 | R547.80 |
POLMED FP Network Consultation Rate Fee Category 2 | R520.90 |
POLMED FP Network Consultation Rate Fee Category 3 | R485.60 |
How should I submit a claim to ensure I continue to receive my REPI² category enhanced fee?
- Continue to submit your claims at the POLMED Network rate, as indicated above and Medscheme will automatically add the additional enhanced fee, where applicable.
- Your remittance advice will show a comment code 247 against each consultation qualifying for an enhanced fee. The enhanced fee rand amount will not reflect on each line. Instead, the sum of your enhanced fees is shown as one amount flagged with code 247 and the description “Enhanced fees” at the beginning of each Scheme’s claim lines.
For example: 100 (consultations) X R35.30 (enhanced fee) = R3,520
Practice to submit claim at POLMED Network Tariff Rate | Automatically added by administrator when claim is processed | ||
POLMED New Payment Structure Effective 01 July 2024 | Base Network Tariff Rate to be claimed | Enhanced Fee Cat 1 | Enhanced Fee Cat 2 |
014 General Practitioner | R 485.60 | R 62.20 | R 35.30 |
015 Specialist Family Physician | R 653.40 | R 62.20 | R 35.30 |
What are other important POLMED related changes that my practice needs to be aware of?
Effective 01 July 2024, the POLMED-focused Family Practice outcomes reporting document, known as the ‘POLMED FP Profile,’ will be discontinued.
The POLMED-only enhanced remuneration categories previously indicated in the POLMED FP Profile will be replaced by the REPI² Family Practice Outcomes Report enhanced fee categories.
See separate communication provided for further information.
Effective 01 July 2024, the POLMED-focused Family Practice outcomes reporting document, known as the ‘POLMED FP Profile,’ will be discontinued.
The POLMED-only enhanced remuneration categories previously indicated in the POLMED FP Profile will be replaced by the REPI² Family Practice Outcomes Report enhanced fee categories.
See separate communication provided for further information.
Kind regards,
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