Frequently Asked Coding Questions

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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