Medical Society Imperial Group Medical Scheme (Imperial Med

Medical Society Imperial Group Medical Scheme (Imperial Med

MEDISCOR (PTY) LTD
Baobab Building, River Falls Office Park,
Rose Avenue, Centurion
PO Box 8796, Centurion, 0046
Tel: (012) 674 8000
Fax: (012) 674 8001
NOTIFICATION 80
OF
2016
21 December 2016
Medical Society
Imperial Group Medical Scheme (Imperial Med)
Administrator
MMI Health - MMSA
Options


Information Relevant to
New Scheme Client - Benefits and Options for 2017
Effective Date
1 January 2017 (date of service)
Imperial Budget Plan
Imperial Health Plan
With effect 1 January 2017, Mediscor will apply the scheme rules applicable to pharmacies
and dispensing doctors for Imperial Med as outlined below.
Herewith the detail for submitting medicine claims to Mediscor:
1.
2.
3.
4.
Claiming Code (PCN)
Switch Destination Code
EDI Activation Code (Dispensing Doctors)
Default Reference pricing
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
Maximum supply of medicine
Days supply of the dispensed medicine
Membership number as per membership card
Dependant code as per membership card
Dependant first name as per membership card
Dependant date of birth
Dependant gender (male/female)
Practice number of the prescriber
9 digit NAPPI code of medicine dispensed
ICD-10 Diagnosis code
Membership number requirements
Payments to Providers
Chronic pre-authorisation
Default Dispensing Fee – Pharmacies
Default Dispensing Fee - Over the counter (OTC)
Default Dispensing Fee – Doctors
PESA Exclusions
MDS0116
OMIM0000
364P
Mediscor Reference Price
(MRP*)
30 DAYS
Yes / Compulsory
Yes / Compulsory
Yes / Compulsory
Yes / Compulsory
Yes / Compulsory
Yes / Compulsory
Yes / Compulsory
Yes / Compulsory
Yes / Compulsory
Minimum 4 numerical
MMI Health - MMSA
MMI - MRM
SEP + 30%/R30.00 (Excl. VAT)
SEP + 30%/R30.00 (Excl. VAT)
SEP + 30%/R33.60 (Excl. VAT)
1-7; 9; 15; 16; 19-25; 27; 2932; 38; 40; 41; 43; 45; 48; 5052; 53; 57; 58; 60-64



Due to the complexities of various levies, co-payments, formularies and
exclusion criteria; service providers must refer to our on-line responses to
apply the correct rules.
Dispensing fees may differ from the default fee where DSP’s (and PPN’s)
have been contracted by the Medical Society.
Dispensing fee structure(s) will be applied on scheduled medicines (0 – 8)
and unscheduled products.
* Refer to Mediscor website www.mediscor.co.za
IF YOU REQUIRE ANY ASSISTANCE, PLEASE CONTACT:
Mediscor’s Contact Centre
:
0860 113 238 or 0860 117 705
Mediscor E-Mail
:
[email protected]
Imperial Med
:
0860 467 374
Please send any questions regarding this communiqué to [email protected]
Kind Regards
ILSE STEYN