Medscheme new error and rejection codes

Medscheme embarked on a path to re-engineer its core systems over a year ago. The aim is to implement a rules based solution over a two and a half year period. The ability to customize funding models and the associated rules, provides new opportunities for Medical Schemes and Healthcare Providers to consider innovative reimbursement models that are sustainable for both parties.

In light of the above, Medscheme deployed the first component of its decision engine after extensive testing, in November 2017. This engine evaluates the validity and eligibility of a claim, whilst the existing core system still applies the benefits and limits and does the pricing and payment of the claim.

This communication highlights the new error and rejection codes that will be applicable on Member and Healthcare Practitioners remittance statements.

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