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1. For queries on Practice Numbers
Please
contact the Board of Healthcare Funders (BHF) on 011 537 0200 or www.bhfglobal.com
2.
List of Prescribed Minimum Benefits
(PMB’s)
Please
go to the Council for Medical Schemes website – www.medicalschemes.com – for the detailed information on
PMB’s.
3.
What is regarded as emergency
Emergency is when failure to
treat the patient immediately, may result in loss of life, limb or significant
complications
4.
LOA tariffs and codes – for insurance
purposes
The
doctor/practice needs to contact the relevant insurance company to get the codes and tariffs
for that particular service.
5.Complains against
medical schemes/Ombudsman for Medical Schemes
The
Council for Medical Schemes (CMS) investigates medical schemes on behalf of
medical scheme members. You can contact them on 012 431 0500. Ask for Complaints. You may also lay a complaint on their website
- www.medicalschemes.com or e-mail to complaints@medicalschemes.com
6.
Procedure/Consultation codes for
Nurses/Midwives
Unfortunately
we do not have the coding structures for Nurses and Midwives. Contact the South
African Nursing Council on 012 420 1000 for assistance.
7.
New eMDCM codes and are they accepted by
medical schemes
New
codes and modifiers are introduced every year from the 1 January. They are in
our structure, they are valid and some medical schemes are accepting them and
some are not. If the medical scheme does not grant benefits for certain
services, the patient will be held liable to settle the account.
8.
Services rendered by non-medical doctors
SAMA only deals with enquiries rendered by medical doctors. Please contact the appropriate association/society for services rendered by all other healthcare practitioners.
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