South African Medical Association



PP4U: Enhanced Pre-authorisation Process for Hospital Benefit Management - Medscheme


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.

Read More

The South African Medical Association - Postal Address-The South African Medical Association P O Box 74789,Lynnwood Ridge Pretoria 0040, South Africa Physical address The South African Medical Association, Block F Castle Walk Corporate Park Nossob Street Erasmuskloof Ext3 Pretoria 0181,
South Africa

If you no longer wish to receive these emails, simply click on the following link Unsubscribe.


Cookie Consent

Our website uses cookies to provide your browsing experience and relavent informations. Before continuing to use our website, you agree & accept of our Cookie Policy & Privacy