Dear Network Doctor and Practice Staff

Our communication of 17 July 2020 relating to Moto Health Care Medical Fund (Custom and Essential Benefit Options) and Wooltru Healthcare Fund (Network Option): Administration platform change effective 1 August 2020 refers.

Kindly find below an additional paragraph detailing specific changes to your remittance advice.

Please be advised that the above scheme benefit options will be migrating to the Momentum Health Solutions (MHS) system, with effect from 1 August 2020. It is important to note that the membership numbers, benefits and all other contact details will remain the same.

We anticipate a smooth transition with some minor operational changes as indicated below:
Membership verification
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The real-time patient verification function will no longer be available on the CareCross website and can be accessed via the scheme navigator site at https://providerlogin.mmihealth.co.za/schemenavigator/scheme-navigator-main.html using your existing login details.
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The scheme navigator site will allow you to verify membership, view your claims history and search for medical scheme rates of all the schemes administered by Momentum Health Solutions. Telephonic verification can also be done via the call centre on 0860 101 159.
Claims submission
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All claims regardless of the service date should be submitted to the MHS platform with effect from 1 August 2020.
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Claims submitted to the previous location will be rejected with the error message “Refer account to administrator for processing”.
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Please note that we will inform the various switching partner(s) of the change in the destination code. We also encourage you to engage your switching partner(s) directly.
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Please ensure you submit claims with the full rand value in accordance to your agreement (if applicable) to prevent any payment discrepancies.
Remittance advice (claims statement) changes
Please note the manner in which you reconcile payments might change due to the following:
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Claims for Wooltru Healthcare Fund (Network Option) and Moto Health Care (Custom and Essential Options) will no longer reflect on the CareCross remittance as a result of the platform change.
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You will receive a combined MHS remittance for the Momentum Medical Scheme Ingwe Option, Wooltru Healthcare Fund Network Option and Moto Health Care Custom and Essential options (Momentum Health4me will remain separate for the time being). Scheme (non-day-to-day) benefits will still be reflected on a scheme remittance.
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Please see below the change in remittances:
Current
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Momentum Medical Scheme statement including Ingwe Option – both scheme payments and MHS payments.
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CareCross statement – with Wooltru Healthcare Fund and Moto Heath Care day-to-day payments together with Pick n Pay Medical Scheme, OCSACare and Horizon Medical Scheme.
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Wooltru Healthcare Fund statement – for scheme risk payments.
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Moto Health Care statement – for scheme risk payments.
New
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Momentum Medical Scheme statement including Ingwe Option scheme payments excluding MHS payments – Change.
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MHS statement with Ingwe Option, Wooltru Healthcare Fund and Moto Health Care day-to-day/out-of-hospital payments – Change.
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CareCross statement with all remaining CareCross schemes: OCSAcare, Pick n Pay Medical Scheme and Horizon Medical Scheme – Change.
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Wooltru Healthcare Fund statement – for scheme risk payments.
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Moto Health Care statement – for scheme risk payments.
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In order to reconcile your payment, you will therefore have to consult both the MHS and scheme remittance advice.
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Please note the reference number on your bank statement will reflect as MOMENTUM PCR with your practice number and remittance advice date.
Authorisations
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All existing hospital and chronic authorisations will be transferred to the new system and will remain valid as per the authorisation/confirmation details received.
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The Zenzele and Business-to-Business (B2B) functionalities used by hospitals will be available to the Wooltru Healthcare Fund Network Option and B2B for the Moto Health Care Custom and Essential Options.
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The email address for hospital authorisation for the Wooltru Healthcare Fund Network Option is hrm@wooltruhealthcarefund.co.za and auths@mhcmf.co.za for the Moto Health Care Custom and Essential Options.
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There will be no changes to existing contact numbers used to obtain pre-authorisation.
Third parties
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All third-party service delivery will remain unchanged.
Thank you for your co-operation and please do not hesitate to contact us on 0860 101 159 for further information in relation to the platform change.
Kind regards
Provider Team
Momentum Health Solutions

 

 

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