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Dear Doctor,?Nedgroup Medical Aid Scheme Family Practitioner Network Scheme Rates for 2020?Nedgroup Medical Aid Scheme would like to thank you for your services rendered to our members during 2019 and looks forward to partnering with you in 2020. There will be a 4.5% increase in the Nedgroup Medical Aid Scheme Family Practitioner (FP) tariff rates as well as the below changes with effect from 1 January 2020. Please take note, to continue as a participating FP on the Nedgroup Medical Aid Scheme FP Network it is not required to sign the Agreement again.?Nedgroup Medical Aid Scheme FP Network Reimbursement Model:?The Nedgroup Medical Aid Scheme FP Network reimbursement model for 2020 will continue to include an enhanced fee in accordance with your REPI? category score as indicated below:?FAMILY PRACTITIONER CONSULTATION RATES (0190 - 0192)Nedgroup Medical Aid Scheme FP Network consultation feeR401.80Enhanced consultation fee for REPI2 category 1 FP Network practicesR44.30?One of the objectives of the Nedgroup Medical Aid Scheme FP Network is to protect members from unexpected co-payments. As such, Nedgroup Medical Aid Scheme would like to emphasise the importance of billing at the scheme rate (R401.80). The participating rates are also available on the Medscheme website on . ??Should you wish to check your patient’s option and benefits go to , log in as a Provider, click Member Benefits, and insert the patient’s membership number and their option details will appear.?Billing Process:?Your remittance advice will show a comment code 247 against each consultation qualifying you for an enhanced fee. The enhanced fee Rand amount will not reflect on each line. The sum total of your enhanced fees is shown as one amount flagged with code 247 and the description “Enhanced fees” at the beginning of each Scheme’s claim line. For example: ?50 (consultations) X R44.30 (enhanced fee) = R2,215.00?New to Nedgroup Medical Aid Scheme for 2020:?Nedgroup Medical Aid Scheme has changed the Hospital Plan to the Hospital Network Plan for 2020. This plan will now offer one out-of-hospital FP consultation. Furthermore, beneficiaries on the Hospital Network Plan will be subject to an admission to a Nedgroup Medical Aid Scheme Hospital Network facility. Failure for Hospital Network Plan beneficiaries to comply with the Nedgroup Medical Aid Scheme Hospital Network will result in a R7,000.00 co-payment. Please refer to the Nedgroup Medical Aid Scheme FP Network Guide for 2020 for more information. ?Specialist Network and Specialist Referral:?Nedgroup Medical Aid Scheme would like to remind FPs that there is a Specialist Network of doctors who will assist members in minimising out-of-pocket expenses. All Nedgroup Medical Aid Scheme beneficiaries (with the exception of the Platinum Plan) must consult their Network FP BEFORE making a Specialist appointment, in order for the FP to ensure that the patient is referred to the appropriate specialist and to avoid a co-payment. ?Should a member voluntarily be admitted into hospital by a non-network FP or non-network Specialist, a R2,500.00 co-payment will be applied on admission to the hospital.?ICPS (Improved Clinical Pathway services) & JointCare, Designated Service Providers for hip and knee replacements: ?ICPS and JointCare are the Designated Service Providers for Nedgroup Medical Aid Scheme members. ICPS and JointCare are a group of orthopaedic surgeons that specialise in performing hip and knee replacements according to standardised clinical care pathways. These care pathways have been developed in accordance with evidence based outcomes to ensure that the quality of the hip and/or knee replacement is of the highest standard and to ensure the best health outcomes. ?Call the Healthcare Provider Contact Centre on 0861?112?666 and you will be given the details of an ICPS or JointCare orthopaedic surgeon closest to you.?If the decision for surgery is made by the orthopaedic surgeon, ICPS and JointCare will ensure payment in full (subject to the prosthesis benefit) with no co-payment for the procedure which will include the following:?All hospital costs Surgeons and anaesthetist feesProsthesis (subject to prosthesis benefit)Physiotherapist (pre-, intra -and post-operative)? ?Continuation of Agreement:?You do not need to sign or return the Agreement again. Should you wish to opt out of the Agreement, please inform Nedgroup Medical Aid Scheme in writing on or before Friday, 27 December 2019. This can be done via email to nc@medscheme.co.za or fax to 0860 222 453. Failing which, it shall be deemed that you agree to the contents hereof and are legally bound thereto. You are also welcome to view the Nedgroup Medical Aid Scheme FP Annexure online by visiting (log in as a provider and click on Networks > E-contracts).? ?If you have any questions, please contact the Healthcare Provider Contact Centre on 0861 112 666.?Kind regards?Nedgroup Medical Aid Scheme ................
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