Ever wondered how the pharmacies that are using a different pharmacy
software such as UNI-SOLVE, PRO-PHARM, WINSCRIPT, PHARMACIST, ALLEGRA and so
on, talk to medical aids by just a click on the computer?
Today, I would like to discuss something that gives you the idea about how the medical aid responses work and how are they transferred
between a computer in pharmacy to a computer in your medical scheme’s office
and back.
Medical aids in South Africa use switches that connect a claim
from a Pharmacy/Hospital to the specific medical aid. As soon as a pharmacist
or an assistant clicks on the claim button on the computer, the switching
companies like Interpharm, Mediswitch, etc. allow the transactions to be
submitted to the medical aids on behalf of the patients.
The role of switching companies in the Health care industry.
1. Their primary role is to provide the
electronic/online claims between the patient and a medical scheme.
2.
Checking the membership status of the patient.
3.
Providing electronic remittance
advice.
4.
Managing and tracking claims.
5.
Claiming, Reversing, and canceling of
the old and current claims done.
6.
Keeping track of all the claims
specific to medical scheme number
7.
Detecting fraudulent claims and
services.
8.
Proof of delivery notifications of the
claims that are processed on your medical scheme number.
9.
Updating the pharmacies/hospitals
regarding the changes in the medical aid codes.
If there is a problem in claim responses from the medical aid,
most of the times it’s the medical aid that is down with their network or it’s
the switch. You might have come across a situation at least once when the
pharmacist/assistant told you the medical is down and claims cannot be processed.
Sometimes a claim might not go through at all and causes some complications and
one cannot reverse the claim either. In
such cases, the switch can help you with the reversals and claims. For example,
you are with Bonitas medical scheme and trying to claim your monthly fix of
chronic medication, all the claims/transactions between bonitas medical aid and
your pharmacy go via a switch called INTERPHARM. If there are any
discrepancies with the claims, interpharm would help with the reversals and processing
of your claims, and the same applies to other medical schemes and their
respective switches.
.
List of Medical
switches in South Africa.
There are four major medical switches that are
currently administering around 151 medical aids in South Africa. Some of them
are direct to the specific medical aids while some have a sub switch under them
that administer specific medical schemes.
- Interpharm ( Medscheme)
- Mediswitch
- Medikredit
- Zieto
Contact details of the
Medical switches.
1. Interpharm
(Medscheme)
Mondays – Fridays:
08h00 - 21h00
Saturdays:
08h00 - 17h00
Sundays and public holidays:
09h00 - 14h00.
After Hour Support:
083 462 6045
Call Centre:
0860 109 103
Call Centre (Outside of SA):
+27 11 671 2112
Fax: +27 12 329 5915
E-mail: info@interpharm.co.za
2. Mediswitch
MediSwitch Head Office
Telephone:
(+27 11) 265 5400
Toll Free Helpdesk:
0800 111 703
Physical Address:
Number 2 River Drive
Riverview Park
Janadel Avenue
Midrand
3. Medikredit:
MediKredit Johannesburg
10 Kikuyu Road
Sunninghill
Sandton
2157
Postal Address:
PO Box 521058
Saxonwold
2132
Switchboard:
+27 (11) 7706000
Call Centre: 086 093 2273
Fax: +27 (11) 7706001
MediKredit Cape Town
Ground Floor
Unit 2B
Black River Park North
Fir Street
Observatory
7925
Postal Address:
PO Box 13129
Mowbray
7705
Switchboard:
+27 (21) 4426620
Call Centre: 086 093 2273
Fax: + 27 (21) 4476975
4. Zieto:
Telephone: 0860 14 25 36 (Please specify that this is a Zieto
query.)
Cape Town Johannesburg
Physical Address: Physical Address:
4th Floor 3rd Floor
Liberty Building Libridge Building
Estuary Precinct 25 Ameshoff Street
Century Boulevard Braamfontein
Century City 2001
7441 South Africa
South Africa
