Submission of Claims via MediSwitch

When capturing claims on the respective Practice Management Applications (PMA’s), the PMA will automatically flag the claim lines that meet the criteria for electronic submissions.

Please note that this is dependent on how the PMA is configured by the software (PMA) provider. Claims that meet the following criteria are generally flagged to be included with the next submission to MediSwitch via SwitchOn™ or Batch submission:

• Claim is linked to a medical scheme that is MediSwitch active
• Claim is linked to a patient that is charged medical scheme rates
• Claim is linked to an account flagged for MediSwitch submission
• Claim is linked to an account type that is configured for MediSwitch submission
• The amount on the claim is reflected under the medical scheme liable column

To obtain the maximum benefit from the MediSwitch electronic claim process, claims should be submitted immediately via the SwitchOn™ online methodology or at least daily via the batch system. This will help to reduce the practice’s claim payment cycles as well as increase their cash flow. 

Refrain from submitting paper claims when submitting claims electronically to the medical schemes. Submitting paper claims to the medical schemes cause a delay in the processing of claims.

After submitting the claim(s) to MediSwitch, each transaction line in the claim will be validated according to medical scheme criteria and MediSwitch will supply detailed line level feedback to the practice indicating accepted & rejected claim(s).

MediSwitch Accepted Claims: This details the claim(s) that were successfully delivered to the medical scheme. Accepted claim lines are listed with a unique reference number or MFBatch. This number can be used for claim tracking purposes.

MediSwitch Rejected Claims: This details the claim(s) that were rejected upfront with the reason for the rejection. Claims rejected did not meet the medical scheme validation criteria and these claims are not delivered to the medical scheme.

Medres: This is an interim report from the medical aid schemes / administrators which serves to provide prompt notification regarding rejected and accepted claims. These claims still require final processing.

Claims that have not been paid within 21 days of submission can be resubmitted without being rejected as a duplicate transaction or resubmission too soon. To do so, the practice can:

• Flag the claim for resubmission after 21 days or
• Use the facilities within the PMA to automatically resubmit all unpaid claims after a specific date specified

If you need more information regarding the resubmission option in your PMA you should
contact your software support consultant.

The total claim submission period to medical schemes is mostly 120 days from service date.  However, there are a few medical aid schemes that allow claim submissions beyond the 120 day submission period. 

Below is a list of these medical aid schemes:



Please ensure that you have the latest SwítchComm Plus (SCP) communications application from MediSwitch. You can contact our call centre toll free on 0800 111 703 to enquire whether you are on the latest version as this will ensure that you have the most up-to-date functionality available.

Also contact your PMA provider to ascertain if you can sign-up for online claiming via SwítchOn™.