Using WEBDesk to track your scheme responses

The MediSwitch WEBDesk provides a valuable tool via which scheme responses can be tracked. These include MedRes - which is the online responses returned by real time enabled schemes and eRAs.
 
Both MedRes and eRA responses are imported to the practices’ PMA for SwitchOn users, into each specific practice’s mailbox for SwitchComm Plus users and into SwitchViewer for SwitchComm users. While MedRes responses provide you with a funder interim notification, eRA responses specify the amount paid by the scheme for each ‘claimed’ line. In the event of a scheme rejection, the rejection code and description of the rejection will be populated on the response.
 
The following participating administrators are currently providing MedRes and / or eRA responses via MediSwitch:

  » Medihelp
  » Discovery Health Administrators
  » Momentum Medical Scheme Administrators
  » The Metropolitan Health Group
  » V Medical Aid Administrators

Here’s a quick guide to help you get going:

Open Internet Explorer and go to www.mediswitch.co.za.

Enter your Username and Password to access the WEBDesk. For first-time users, please call the MediSwitch Call Centre on 0800 111 703 to get your unique User ID and Password.

Click on the ‘Claims Online’ drop-down menu to access the options below. Then click on ‘Medres / ERA’.

This will open a screen that enables you to search using a specific date range. We recommend that you select a 10 day search cycle. For example, if looking to see a Medihelp remittance from April, you would type 2011/04/01 in the BETWEEN field and 2011/04/10 in the AND field. Under ‘advanced options’ it is recommended that you leave the selection to ALL as per the screen shot below. Then click on SHOW to display the information. The tabs in the top right hand corner of the screen will enable you to maximize your page and print the report or save it as a PDF document.

An example of scheme responses from Medihelp:

	Response Description
U - Uploaded	0 - Your claim was successfully received by Medihelp on 02/04/2011
P - Paid full	0 - 7008 Suspected Duplicate, 0 - 7161 Claim in excess of Medical aid rate, 0 - 7312 PMB claims overcharge
R - Rejection	0 - 109 Modifier combined with previous tariff., 7121 - No benefits according to Scheme rules, 7161 - Claim in excess of Scheme rate, 7661 - PBM Related Diagnosis No Authorisation, 7666 - Hospital Theatre time claim not yet processed
P - Paid full	0 - 7312 PMB claims overcharge, 0 - 7163 Claim paid above scheme rate
P - Paid full	0 - 7164 Claim paid at cost for services rendered
P - Paid full	0 - 7666 Hospital Theatre time claim not yet processed, 0 - 7164 Claim paid at cost for services rendered
P - Paid full	0 - 7161 Claim in excess of Medical aid rate
P - Paid full	0 - 7666 Hospital Theatre time claim not yet processed, 0 - 7161 Claim in excess of Medical aid rate, 0 - 7008 Suspected Duplicate
P - Paid full	0 - Your claim was successfully received by Medihelp on 05/04/2011, 219 - Member number '4242467' with DOB '19280605' not found.
R - Rejection	0 - 7181 Authorisation has Claim notes, 0 - 7163 Extended benefits applied to services rendered
P - Paid full	0 - 109 Modifier combined with previous tariff.
P - Paid full	0 - 7181 Authorisation has Claim notes, 0 - 7163 Extended benefits applied to services rendered
R - Rejection	0 - 7164 Claim paid at cost for services rendered

We are confident that this scheme response tracking tool will add value to your practice and enhance your practice management procedures. We therefore strongly recommend that you make use of the MedRes/eRA facility which is accessed via the MediSwitch WEBDesk to ensure optimal claiming.

- James Chirwa