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Enhanced Pre-authorisation Process for Hospital Benefit Management - Medscheme
The following excerpt from Medscheme's pre-authorisation rule in a circular to service providers and administrative staff:
Please take note that Medscheme has sent out the following notification regarding Pre-Authorisations with their Hospital Benefit Management from 13 September 2018.
For ALL of the following instances:
- In-hospital admissions
- Doctor in-room (in lieu of hospitalisation) procedures
- Specialised radiology
- Renal dialysis
- Physiotherapy benefits if required by the scheme
- Any other type of in-hospital authorisation request for all Medscheme administered Schemes
Please complete all 6 mandatory fields:
1. Treatment date: When is the person being admitted?
2. Member and beneficiary number: Who is being admitted?
3. Treating provider practice number: Who is the treating healthcare professional?
4. Place of service practice number: Where is the person being treated?
5. Relevant diagnosis and/or procedure codes: Why is the person being admitted?
6. In- or Out-of-hospital indicator: Will the person be admitted as an in-patient or be treated as an out-patient?
IMPORTANT NOTE: If any of these 6 basic mandatory fields are not completed, the pre-authorisation request will not be acknowledged or captured into their systems. No reference number will be generated and no claim will be processed without the applicable authorisation number.
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