LIST OF ALL MEDICAL AID SWITCHES IN SOUTH AFRICA

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.

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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.

1.               Interpharm ( Medscheme)
2.              Mediswitch
3.              Medikredit 
4.              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

enquiries@medikredit.co.za

www.medikredit.co.za

www.medikredit.net

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

enquiries@medikredit.co.za

www.medikredit.co.za

www.medikredit.net

4. Zieto:

Info:  info@zieto.co.za

Web: webmaster@zieto.co.za

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