FAQs

Products:

Electronic Data Interchange (EDI) is computer-to-computer exchange of documents in an electronic format. Claims switching is essentially the electronic way of submitting medical aid claims to various medical aid administrators via an EDI supplier.

It is the submission of a collection of different patient medical aid data/information submitted to the scheme in one bundle.

It is the submission of single patient medical aid data/information submitted to the scheme immediately; in actual real-time. Real-time claiming refers to the immediate and complete adjudication of a healthcare claim upon receipt by the medical aid. This feedback happens within seconds of submission.

Depending on the type of practice and processes within your practice you will have a choice between batch or real-time claims submission. Visit our product page to see which product is right for your practice.

MediSwitch validates claims on behalf of the medical aids according to the medical aid scheme rules. If the claim adheres to the MediSwitch upfront validation, it is sent through to the medical aid scheme administrator for processing.  If it does not adhere to the upfront validation, it is sent back to the practice with a rejection code.  This gives the practice the opportunity to correct the claim and resubmit it. MediSwitch does not charge practices for upfront rejections.

PMA is an acronym for Practice Management Application. It is software that enables you to capture patient details, submit claims electronically via a switch to medical aid scheme administrators and process billing.

It depends on the PMA used by your practice. Click here to see the list of PMAs that we are integrated with. These PMA vendors provide training and support on using their software.

PMAs that are integrated with MediSwitch:

Med-e-Mass ME +
Med-e-Mass Elixir
ElixirLive
Med-e-Mass Mastermed
Goodx
Made-To-Measure
Medis 2000
Health Focus
MediCharge
Exact
Optimax
Solumed
Ikat
MedAP
KaraboIT
KPC-Atlas: Pienaar and Partners
Medistat
Anaest-Easy: A E Systems
Medinol: Better Practice Management
Mediq II: Gandiva Software CC
Denmed: W A Computers
Delta9
HIMS – Healthcare Info Systems
Webxperts CC
GAEA
Infinitt
Famdoc
Turbomed
Med Manager
Radpac
Pracsoft
Smartprac
Optics3
e-Novate – Tactec
Toga Laboratories
Allegra Pharmaceutical Care
Micromed: Ben Bodenstein Associates
Prac Management Sys: Crystal Solutions
Hybrid Digital (Pty) Ltd – Calico
Cryptex Data Solutions – Cryptex
Phakama Information Technology – DataWise
Practice Management Consulting – Pracmed
Torga Optical (Pty) Ltd

Services:

All you need to do to start receiving the MediSwitch WhatsApp scheme updates and news alerts is follow two easy steps:

  • Step 1: Add MediSwitch as a contact on your cell phone. You must do this in order to receive scheme updates. Our number is 084 401 4998.
  • Step 2: Send us an SMS (not a WhatsApp message) with your full name and practice number so that we can add you to our WhatsApp community.

You can chat to us directly via WhatsApp, but you will not receive messages from anyone else. We will also never share your details with anyone else.

If you ever want to stop receiving updates, simply send us a WhatsApp with the message “STOP”.

Please note that it may take a few days for you to be added to our system, especially when we experience a high volume of sign-ups.

Your personal information stays private. MediSwitch only sends updates to you and no information is given to 3rd parties.

No – your information is not given out.  We will only communicate relevant information pertaining to MediSwitch services and scheme updates.

MediSwitch does not charge for this service but your cell phone provider’s data costs will apply.

Customer services:

Our call centre agents are available to assist you Monday through to Friday from 7am to 6pm and on Saturdays, from 8am to 1pm.

Our Account Manager Locator, are knowledgeable specialists in all areas of the switching process and visit practices personally on a regular basis. They pass on information regarding our latest developments and help practices get the most from MediSwitch products and services.

Visit the Account Manager Locator to see which Account Manager is designated to your practice.

We offer free claims management workshops as well as medical receptionist workshops (R1800 per delegate) nationwide. To find out when the next workshop will be in your area, visit our training page here.

You can request your invoices from our Registrations team by sending an email to: accounts@mediswitch.co.za. To ensure that you receive your statement and invoices timeously, please send your email address to accounts@mediswitch.co.za.

Updating your details can be done in one of the following ways:

  1. Send an email to registrations@mediswitch.co.za.
  2. Login to WEBDesk and under the Profile menu button, click on Practice Details. Then proceed to update the editable fields you want changed.

MediSwitch is obligated to store and upon request, provide your practice with proof of delivery/submission for claims submitted during the last 12 months only.

All you need to do is login to WEBDesk and fill in an eRA consent form. Select the scheme administrator(s) which you would like to receive eRAs from and complete the compulsory practice consent fields and submit.

Consent forms for the selected scheme administrators will automatically be generated and sent off – all done in one form! You will start receiving eRA’s as soon as the scheme administrators have activated this service for you.

The Daily Action Report is designed to assist your practice in dealing with any issues requiring attention from the previous day’s claim submissions. You have the option to receive the report in PDF or Excel.

The report is sent each morning, via email and contains the following tabs:

TAB NAME HOW TO USE THE INFORMATION
MediSwitch: This displays all claims rejected by MediSwitch’s upfront validation process. These rejections need to be corrected and resubmitted as soon as possible. Use the supplied Rejection code(s) and Description(s) column to fix the errors on the claim lines.
Scheme: This section indicates responses received from the medical aid schemes. The information will either contain rejections, errors or part-payments. Please note that this tab contains all rejections at scheme level. Always cross-check the dates of rejections to ensure that you don’t resubmit claims that you have already corrected. We recommend that you follow up with respect to part-payments to ensure uninterrupted cash flow to your practice.
eRA: This tab displays a summary of the electronic remittances received from the medical aid scheme administrators.

eRA Detail: Contains detailed data of all the electronic Remittance Advices (eRAs) received from the various medical aid scheme administrators. These will either contain rejections, errors or part payments.

Simplify and speed up your payment reconciliation processes by checking the total amounts paid by the scheme against your submitted claims. Remember to follow up on any co-payments as soon as possible.

Claims submissions:

It is good practice to follow up on rejected and unpaid claims within 14 days of receipt. It is vital that your practice acts upon rejected claims on time to ensure timely payments from the medical schemes.

Medical schemes will consider a claim as stale after 120 days.

All healthcare professionals can send Injury on duty (IOD) related claims to the Compensation Fund electronically through MediSwitch.

The MediSwitch codes to facilitate the electronic submission of your injury on duty claims are as follows:

Activation Code: 454P
Destination Code: CFIO0001
Claiming process:
The claims are submitted using the normal claiming process and by utilising the Compensation Fund tariffs which are available from the offices of the Compensation Fund.

Visit https://www.youtube.com/channel/UCq_1cIfDZ4nTLbB5VUnwVWQ to view step-by-step tutorials on how to submit IOD claims via MediSwitch.

WEBDesk:

Go to  https://webdesk.mediswitch.co.za/ and enter your username i.e. your practice number and the active ID you are using to transact your claims.

Go to https://webdesk.mediswitch.co.za/ and click on the “forgot password” link. An email will be sent to your email address with a temporary password.

You can view the status on each claim line to assist with claims tracking. The claim status notification details are represented as:

C= Confirmed as received by the medical scheme.
U= Claim has been uploaded on to the scheme’s system for processing and payment.
M= Medical scheme’s response (Medres) for the claim.
E= electronic Remittance Advice (eRA) available for the claim.
P= Proof of delivery per claim line. Clicking on this will automatically open a dialogue box requesting you to save or open the POD certificate. You can print the copy at your convenience.

Medical aid schemes and administrators:

  • Discovery
  • Medscheme
  • Metropolitan Health Group
  • Momentum (for GPa only)
  • Medihelp

In order to manage expectations with respect to the time it takes to receive payment from destinations, we have put together a list of the different destination types and their obligations in terms of payment.

MediSwitch process and deliver claims from healthcare professionals to the following different destinations:

Self-administered medical aid schemes

  • These schemes are duly registered with the Council for Medical Schemes and adhere to the requirements as set out in the Medical Schemes Act and regulations pertaining to the Medical Schemes Act.
  • Their daily operations, namely the maintenance of membership lists, claims processing and payment of such claims, are carried out by staff that are employed by the particular scheme. Examples of self-administered schemes are:
    • Bestmed
    • De Beers Benefit Society
    • Genesis Medical Scheme
    • Medihelp Medical Scheme

Schemes should process and pay all claims for reasonable healthcare services within 30 days upon receipt of the claim. In the event of any dispute arising, the medical scheme has 60 working days from the date that the dispute was logged to respond to the complainant.

Medical scheme administrators

Medical scheme administrators are accredited with the Council for Medical Schemes to administer medical aid schemes that are duly registered with the Council for Medical Schemes. A medical aid scheme would contract the administrative functions of the scheme to an administrator. The administrator is responsible for the daily operations with respect to the maintenance of the membership of the scheme, and claims processing as well as payment of claims on behalf of the scheme.

An example of an administrator is Thebe YaBophelo Healthcare which is responsible for the administration of Hosmed and Thebemed.

The same regulations apply to medical scheme administrators with respect to the processing and payment of claims as those applicable to self-administered schemes.

Third party administrators

Indicates that there is a third party duly contracted to a medical aid scheme and administrator to process claims on behalf of the medical aid scheme.

Specialised services are typically contracted to a third-party administrator on behalf of the scheme. An example of a third party administrator is Denis which manages dental benefits on behalf of Keyhealth for all the schemes’ benefit options/plans. The end destination to which a claim was delivered can be found on the MediSwitch WEBDesk. Click on the destination date and the details of the end destination will be displayed.

Pharmacy benefit management and managed care organisations

These organisations are duly accredited with the Council for Medical Schemes to manage the medicine and hospital benefits on behalf of a medical aid scheme.

An example of a pharmacy benefit management organisation is Mediscor PBM and an example of a managed care organisation is Medical Services Organisation (MSO).

Healthcare insurance organisations

Healthcare insurance plans are not traditional medical insurance plans and the providers of these plans are not registered with the Council for Medical Schemes.

Medical insurance health plans are designed to prevent catastrophic financial strain in the event of medical emergencies, while also providing coverage for the kind of medical expenses that an average, relatively young and healthy person might need. The providers of medical insurance plans are authorised financial service providers that are regulated by the Financial Services Board and the National Credit Act.

Examples of insurance product organisations are Oneplan, GetSavvi and Unity Health.

The Compensation Fund and Rand Mutual Assurance

The Compensation for Occupational Injuries and Diseases Act (COIDA), Act 130 of 1993, is the governing Act that deals with occupational injuries and diseases. COIDA is governed by the Department of Labour and not the Council for Medical Schemes.

Invoices pertaining to injury on duty events delivered to the Compensation Fund and Rand Mutual Assurance for processing and payment are more complex than invoices delivered to medical aid schemes.

The payment of an invoice is dependent on a number of factors. These include:

  • Was the reported injury an injury which was sustained within the course and scope of the employee’s employment?
  • Is there a first medical report to confirm ICD10 code(s)?
  • Is the employer registered and up to date with premiums payable to the Compensation Fund and RMA?
  • Has liability been accepted?
  • Is there a subsequent (progress) medical report to support the medical invoice?
  • Has authorisation been requested for reopening of events older than two years?
  • Does the invoice contain the Compensation Fund or RMA claim number? Without the claim number, no payment can be made and the invoice will be soft deleted with the appropriate remittance emailed to the medical service provider.

It is important to note that both the Compensation Fund and Rand Mutual Assurance respond to invoices submitted within a period of 90 days from receipt, whereas medical schemes will process and pay claims within 30 days from receipt of such claims.

You can view the status on each claim line to assist with claims tracking. The claim status notification details are represented as:

C= Confirmed as received by the medical scheme.
U= Claim has been uploaded on to the scheme’s system for processing and payment.
M= Medical scheme’s response (Medres) for the claim.
E= electronic Remittance Advice (eRA) available for the claim.
P= Proof of delivery per claim line. Clicking on this will automatically open a dialogue box requesting you to save or open the POD certificate. You can print the copy at your convenience.

Coding:

The Council for Medical Schemes and the National Department of Health support the implementation of ICD-10 in the public and private health sector. This is a diagnostic coding standard that was adopted by the National Department of Health in 1996 and is now the responsibility of the National Health Information System of South Africa (NHISSA). It is a diagnostic coding standard that is accepted by all the parties as the coding standard of choice. [Reference – Final Document, ICD-10 implementation, August 2004]. Click here to view the updated ICD10 Master Industry Table (MIT)

Customer support & contact centres: